Gerry Adams (Louth, Sinn Fein)
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I move:

That Dáil Éireann:notes that:

-- international best practice in treating children who are profoundly deaf is for the provision of bilateral cochlear implants;

-- children in this State who are profoundly deaf are only provided with one implant;

-- the absence of a second implant creates problems for these children in differentiating speech in noisy environments, as locating the direction of a sound makes the stress of trying to hear exhausting; and

-- it is a race against time as the auditory nerves to which the implants are connected become more redundant every day and will eventually die if they are not being used; unless implants are connected in the early years (that is by the age of 7 or 8) it is accepted that the operation will be ineffective;

further notes:

-- the provision of cochlear implants for children is an issue of fundamental rights;

-- there are around 200 children throughout the State who may be able to avail of this service;

-- the estimated cost to the State is approximately €12.8 million per annum; and

-- the sterling work being carried out by the specialist cochlear implants unit in Beaumont Hospital;

commends the parents of the children who through their Happy New Ear campaign have raised awareness of this issue; and

calls on the Government to ensure that:

-- the proposed business plan by the Health Service Executive (HSE) and Beaumont Hospital to introduce a bilateral cochlear implant programme is contained in Budget 2014 and is part of the 2014 HSE estimates process; and

-- children who are profoundly deaf receive the most effective care possible and that international best practice is applied.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Is that agreed? Agreed.

Gerry Adams (Louth, Sinn Fein)
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Billy Cairns is from Dundalk. He is just four years old and like all children of his age he is friendly and smart. He is also hugely courageous and profoundly deaf. I mention Billy because his was the first cochlear implant case I raised here. I could also talk about Alex, Anna, Ben, Ellie, Grace, Fionn or many others. Billy was one of several children whose parents asked to meet me in January and they are an amazing group of mothers and fathers. They are committed, dedicated, imaginative, unstinting and tireless in their determination to get the very best for their children. They will travel anywhere, meet anyone, and present a compelling account of their experience and of their hopes and demands for their páistí. Their web site is clever and informative. I logged on again last night and listened to Emeli Sandé sing her evocative "Read all about it" in which there is the line, "You've spent a life time stuck in silence" and watched the video as children and parents tell their story. All of us in the Dáil, from all parties and none, who have met the children and their parents have been moved and motivated by their courage and example.

I commend the Happy New Ear campaign and I welcome the parents and some of the children to the Gallery today. I first met the parents and some of the children in my office in Dundalk in February. Later a group of parents came to the Dáil to make a presentation to a cross-party group of Deputies. Since then they have lobbied politicians, doctors, HSE officials, the Joint Oireachtas Committee on Health and Children and the Minister for Health on the issue. This is an issue of fundamental rights. All of these children were born with profound hearing loss, but medical science has provided a means by which many of them can hear. We have the cure for many of these children. It means providing a surgically implanted electronic device, called a cochlear implant, which provides a sense of sound to a person who is profoundly deaf. The operation is difficult, and especially so for children who may have to undergo several procedures requiring a general anaesthetic.

In this State the health policy for the past 17 years has dictated that a patient receive only one cochlear implant. This means the children who go through the operation have hearing in only one ear. As one of the mothers said to me a long time ago, it is like giving a blind child sight in only one eye. This is despite the fact that international best practice dictates children receive bilateral implants. In the North, in England and throughout the European Union a child will receive two implants. This is also what the HSE now recommends. Ag an pointe seo, tá sé measta go bhfuil timpeall 200 páisti a d'fhéadfadh buntáiste a bhaint as na hionchlannáin cochla dáthaobhach. Tá an cóir leighis is fearr tuillte ag na páisti seo.

It is a fact that children who go through life with hearing in only one ear face serious hurdles. There are better educational outcomes if a child can hear with both ears. It allows them to determine where sounds come from, which is vital in a noisy environment such as the Dáil Chamber, a playground, a football or hurling pitch, a shopping centre or a crèche. They have a sense of confidence if they can hear the voice of their mother or father. It also gives these children the ability to communicate with others and make friends with other children and not be socially isolated.

The overall amount of additional money required to provide this service is approximately €12.8 million per year. As we have discussed, all of this would not have to be provided upfront. As capacity to perform the operations builds the funding can be provided incrementally. It is not a prohibitive amount. It is the children's right but it also makes economic sense for citizens to live independent lives. The implementation of minimal international best practice would have a huge lifelong positive impact on the lives of these children and their families. Dá gcuirfeá an dea-chleachtas idirnáisiúnta seo i bhfeidhm, bheadh impleachtaí thar a bheith dearfach aige ar saol na bpáistí seo.

Young Billy, who I mentioned at the beginning of these remarks, and whose mother Deanna is with us today in the Gallery, went through an operation last April to replace his faulty implant. Before the operation I raised his case on Leaders' Questions. I sent word to the Taoiseach quietly in advance so he would not be bounced on this important issue. I gave him a note on it. He was sympathetic and promised to raise the cochlear implant issue with the Minister for Health, Deputy James Reilly. I also suggested that when Billy was getting his faulty implant fixed a second implant could be fitted. Again, the Taoiseach was sympathetic. I spoke to the Taoiseach again at least twice privately and in detail. I also spoke to the Minister, Deputy Reilly. I wrote to the two of them and briefed them fully on the general issue of these profoundly deaf children's needs and their right to have bilateral implants. I followed this up in a persistent and consistent but low-key way.

Despite the sympathy and positive responses, Billy went on to have his operation but no second implant. This was an opportunity missed. The operation would have cost €18,000 and this would have been taxpayers' money well spent, but it was refused by the Government. The Government had plenty of notice on the issue. With respect to the Minister of State, Deputy Lynch, I cannot help but compare the Government's stinginess in Billy's case with its generosity with public moneys when it comes to giving a digout to those in financial and banking institutions. When Billy had his operation he could say only one word, and interestingly enough that word was "No". Billy now has 16 words and has discovered the magic of music.

However, the fault in the implant and the lack of a second implant means he was unable to begin school in September and he will not begin until next September. He will also need a special needs assistant and ongoing speech and language therapy.

It just does not make sense. Why do this when we have the means to sort it out? This would be the case even if the child did nothing but enjoy music. Leaving aside his potential and all of the possibilities for his life, surely that is something very compelling.

This was Billy's fifth general anaesthetic, which is a traumatic and potentially dangerous experience for such a young child. When his implant failed, he was plunged back into a world of silence. Imagine that, even as an adult, a person is forced back into silence for six weeks. How does one explain that to a baby?

In these circumstances, it would have made sense for the HSE to agree to provide the resources needed to insert the second bilateral cochlear implant as the surgeon was replacing the faulty one. If Billy Cairns, or Anna Murphy from Westmeath, who faced a similar problem, had had two implants, they would not have lost all sound for that period and they would not have been left to learn to listen and to understand all over again. No child should have to go through this. As I said earlier, this is not hugely expensive but it would make such a huge difference to these children. In fact, it would probably save the State in the long term because, if they end up profoundly deaf, the State would have to spend more money providing care for them throughout their lives. It would also make a huge difference to their making a positive contribution to society.

In working with the parents in this campaign, I have met medical professionals who are a wonderful, inspiring example of what public service is about. One of them is Dr. Laura Viani, the ENT surgeon who first established the cochlear implant programme in Beaumont Hospital. She has been a tireless campaigner, with the parents, in seeking to ensure this service is provided for those who need it on the basis of clinical need rather than ability to pay. Sin rud an tábhachtach - on the basis of clinical need rather than ability to pay. She could have set up a private practice but such is her inspirational sense of duty and commitment that she has given decades of dedicated and selfless public service on behalf of these children who are profoundly deaf. I would like to welcome her to the Dáil and to thank her publicly on behalf of all Teachtaí for the great work she has done and the great work we hope we can help her to do in the time ahead.

In July, Dr. Viani came to Leinster House to make a presentation to a cross-party group of Teachtaí and Seanadóirí, and impressed on all of us the benefits of introducing this programme. She showed several videos of children reacting with amazement and joy as their implants are turned on for the first time - the Minister of State should see those videos. Several parents also briefed us that day and warned of the huge stress their children suffered when the single cochlear implants broke and they were returned to a silent world.

Ní seirbhís seo a féidir le na páistí seo fanacht ar. Tá sé uathu láithreach. As I said to the Minister of State privately, I was very disappointed with the Government's amendment to the Sinn Féin motion. Of course, I am happy the cochlear implant programme has provided devices for 700 patients, which is good. However, where is the sense of simply noting recommendations made by the National Audiology Review Group? That is not the same as implementing the recommendations.

The first meeting of the Oireachtas all-party group on cochlear implants was held in May. It was very well attended, with 17 Teachtaí and Seanadóirí from all the parties and Independents there, and with apologies from some who were otherwise engaged. Every Teachta and Seanadóir I have spoken to on this issue, or who has been lobbied by the Happy New Ear campaign, says they believe these children should have bilateral cochlear implants. The campaign is non-party political and, indeed, as an issue, it should be above party politics. These children cannot hear because they are profoundly deaf. The Government does not have that disability. The Government does not hear thus far because it will not listen. I still have the hope that the Government will listen and that the HSE service plan will include the business plan from Beaumont Hospital, which has been with the Government for a considerable time. The parents had a hope that the business plan would have been in some way included in Tuesday's budget. In working with them, I tried to ensure they did not build up a false hope, but they had that hope. Perhaps the reason they did is because of the positive way the Minister for Health spoke when they raised the issue with him. Of course, it did not come up in the budget and it is now awaiting clearance for the political go-ahead.

Our motion is very clear and unambiguous whereas the Government's amendment is a fudge. There is no action plan, no commitment to introduce the bilateral cochlear implant programme, no commitment to include this programme in the 2014 HSE estimates process and no timeframe for implementation of the HSE-Beaumont business plan. What the parents want to hear and have certainty on is a clear commitment from Government to a time-framed implementation for simultaneous bilateral cochlear implementation. It is a simple "Yes". Forget about the amendment. The Government is either going to do it or it is not. If it is going to do it, why put everybody through this with such a silly amendment?

It is over to the Minister. The Government needs to act. The children and their parents are in a race against time to ensure - this is a crucial point - the children have the operation before they are too old for it to be effective. The reality is that unless these implants are connected in the early years of a child's life, by the age of seven or eight the operation will be ineffective as the nerves will have died off. After that, children born and raised in silence may never speak, something which will adversely impact on them for the rest of their lives.

The Proclamation is very clear and pledges to cherish all the children of the nation equally, and to guarantee "equal rights and equal opportunities to all its citizens''. These young citizens have already faced great adversity in their short lives. They deserve the same rights and opportunities as every other child and every other citizen in the State. The Proclamation does not say we will cherish all the children of the nation equally, except the ones who are profoundly deaf, except the ones who have disabilities or except the ones who come from poor backgrounds. It says "all" of them. These páistí have the right to hear, the right to be heard and the right to have a voice. The Government can deliver all of this at relatively little expense.

The Sinn Féin Private Members' motion calls on the Government to ensure that the proposed business plan by the HSE and Beaumont Hospital to introduce a bilateral cochlear implant programme is contained in Budget 2014 and is part of the 2014 HSE estimates process. I commend that to the Minister and ask Members to oppose the Government amendment and support the motion.

Jonathan O'Brien (Cork North Central, Sinn Fein)
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I was asked to speak on this Private Members' motion and, to be honest, I did not know what to say because how does anyone explain to parents of profoundly deaf children that it is Government policy that, for the sake of €18,000, the provision of a second cochlear implant is not going to happen. I tried to imagine what it would be like to be plunged into a world of silence because I have not experienced that, as none of us in the Chamber have experienced it. It is very hard to understand what those children have to go through on a daily basis. If the Chair will bear with me, I want to try to give some example of what those children have to endure because of a lack of funding or a lack of political will and commitment to provide the funds which could make a huge difference to people's lives.

I will do so by saying nothing for the next two minutes so there will be some understanding of what those children must endure.

That was two minutes of silence. Unless there is a change in policy, a commitment is given and the funding of €12.8 million is provided, which is not much in the bigger scheme of things, the awkward silence of those two minutes in this Chamber is representative of the lifetime of silence for those children. I plead with the Minister, on a human level, to do the right thing and provide the funding to give every child the opportunity to listen and hear, a gift we in this Chamber enjoy every day. If two minutes here felt awkward, I can only imagine what a lifetime of silence would be like.

Dessie Ellis (Dublin North West, Sinn Fein)
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Many of us take for granted the beauty that is the gift of hearing. It is something we rarely consider and something we even curse at times in these days of constant din. Dublin is a noisy city and Leinster House is a noisy place with the constant chatter, the whirr of air vents, the clinking of radiators and so forth. We try to drown much of this out and to ignore the noise of daily living - the busses passing the window, car horns, sirens and the crash and bang of works going on around us. Those of us with the gift of hearing take for granted the wonders it provides every day. We deal with so much background noise and intrusion that we too often fail to consider how lucky we are to be able to hear the voices of our loved ones every day, the splendour of music from voice and instrument and the lyrical use of language in daily conversation. It is impossible to describe just how much life is enriched by our ability to hear everything from a baby's cry to the grandest flourishes of Beethoven.

It is rare that we are given the potential to bestow such an amazing gift on a person. It is impossible for me to understand how it must really feel to go from a world of silence to a world of music, voices, clatter, bangs and cries of passion, anger and joy. It must in some way be a rebirth. Anybody who doubts this or believes me to be verging on hyperbole should go to their office and search "cochlear implant" on YouTube and watch one of the many videos of children experiencing the beauty of music or hearing their mother's voice for the first time. There is wonder on their faces and tears for their families, joyous in the knowledge that life has just become richer and more profound for their loved one. They have awoken to a world of sound. We can be dulled by the fullness of our senses, by the daily assault on them by the excess in this modern world. It brings to mind Patrick Kavanagh's poem "Advent", which speaks of the "...newness that was in every stale thing ... When we looked at it as children: the spirit-shocking". The gift of hearing is just that, a gift that will bring a newness to the world of these children which will enrich their lives forever.

This gift must be provided now for a generation of children, or their window of opportunity will be lost. That is why we raise this in the motion before the House. I commend the work of Happy New Ear, the group of families who have spearheaded a campaign to give their children and future children the gift of hearing. Their work is most valuable. They have done a great deal to bring the beauty of sound to their children's lives, and it is now our turn to help them. This is a realisable goal. The money required is relatively small and it is a positive investment in our young, the next generation of Irish people. The cost is just €12.58.

At present, children in Ireland receive only one cochlear implant, but international best practice recommends two. In many ways, this is a very mean practice in penny pinching. We have recognised that children should get cochlear implants, but not that we should bother to do it right. If it is worth doing, it is worth doing correctly. We know it is worth doing so, logically, two cochlear implants for each child is exactly what should happen. The cost of a single implant is between €18,000 and €20,000. Provision of only one implant limits a child's ability to distinguish where noises are coming from and his or her ability to hear in busy or noisy places. It is a start, but to really benefit a child two implants are required. They require the two implants sooner rather than later. There is only a limited period when the implants will be possible, due to the death of nerves in the ear which are needed for implantation. This is a race against time and every day we delay in changing policy to entitle children to two implants is a day closer to the time when the window closes and their hearing will be irreparably limited.

Current policy is that we must help these children, but only a little. That is not good enough and too many children have been already failed as their window for full hearing has closed. Two implants also allow for limited hearing when one implant malfunctions. At present, children with one implant in need of repairs are thrown back into silence and are doomed to experience this temporary silence intermittently throughout their lives.

In July, Sinn Féin hosted a briefing by Happy New Ear and Dr. Laura Viani, who is the surgeon with the cochlear implant programme in Beaumont Hospital. The parents met the Minister for Health, Deputy James Reilly, on Tuesday and they spoke to the Oireachtas committee on health. Dr Viani warned that unless these implants are connected in the early years, by the age of seven or eight years the operation will be ineffective. After that, children born and raised in silence never speak and that is a huge difficulty which adversely impacts on the rest of their lives. She explained that international best practice calls for bilateral implants to be provided. This significantly improves their quality of life. For the child it is a "journey out of silence." Dr. Viani posed the question, "If you are told you need glasses would it make sense to give you only one lens?" It is so with the children who need bilateral cochlear implants.

It is detrimental for the child to go through the trauma of the three-hour operation for only one implant.

Two of the parents warned of the stress to their children when their single cochlear implants broke and they were returned to a silent world. This caused the children huge distress. This is not just an issue of doing the right thing by these children. If looked at coldly, it is an economic issue. Like many health issues, the cost of not addressing it far outweighs the cost of meeting it head-on and investing in a solution. Children who are deaf require greater educational support and special care packages and often suffer serious psychiatric and depression problems later. They also have difficulty getting work. With cochlear implants, they can make a positive contribution to society and find it easier to get employment. The issue is now on the agenda of the Government thanks to the efforts of the parents. As political representatives, our responsibility is to support their efforts and to do all we can to ensure the Government takes the right decision in the upcoming period.

In the Sinn Féin pre-budget submission we showed how bilateral cochlear implants could be paid for before considering the more long-term saving the State would make in the care and support needed for children who are deaf as they grow up and enter adulthood. We know the Government has no interest in introducing fair tax-and-spend models as represented by our budget. We know it likes to go for the soft targets and cut from those who have nothing to give, but its members should listen in respect of this issue at the very least. A sum of €12 million could and should have been found. This is too important an issue for too many children and their families. When we have a solution to a terrible problem in our grasp, when we know it is possible, when we know it can be done and all we need is the political will of those in power, it is harder to take when it is not done. I am not in the habit of applauding this Government but if it can meet this demand then that is the only reaction I could give. This is such a simple case of the right thing to do not being done. Here is the opportunity; the Minister should do it.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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I find it hard to believe that we are arguing for this. Perhaps I am naïve, but I thought this was a no-brainer and that the Government would stand up in the House on Tuesday and announce it had made funding available for bilateral cochlear implants. Alas, that was not the case. I am proud to stand in solidarity with these kids and their families and friends. Our party is committed to ensuring that the Government makes funding available as soon as possible.

A year ago, when Minister of State, Deputy Lynch, and I were at the Disability Federation of Ireland pre-budget event, I called for a threshold of decency on disability supports. That is a promise from members of every political party and none and a political consensus that they will not cut supports for disability. Unfortunately, we have not signed up to the threshold of decency idea. In a real republic all citizens are equal, but not here. These profoundly deaf children are not equal, despite the fact that we can change this relatively easily. Last year, we were struck by the bravery of citizens with profound disabilities in protesting outside Leinster House at the cuts made by the Minister for Health, Deputy Reilly. The courage and dignity of those who braved the elements to make their stand shone a light on the reality for them, their carers and their families. Despite the promises of both the Taoiseach and the Tánaiste in the final pre-election leaders' debate last year, the Government has proceeded to enforce cut after cut on those with disabilities in this State, their families and their carers. Their broken promises on disability are the cruellest of all.

In Ireland, profoundly deaf children receive only one cochlear implant. This is the same as providing a child with glasses with only one lens. It is wrong, cruel and unacceptable. These children have a limited time window for the implants to be successful; dragging our heels is simply not an option. The cost is a measly €12.58 million in the context of the overall budget and the impact it will have. It is unthinkable that the Government cannot do it, as it is a small price to pay to give children the opportunity to hear.

I attended a briefing in the AV room prior to the recess with the Happy New Ear group and Dr. Laura Viani, the surgeon with the cochlear implant programme in Beaumont Hospital. I was really touched by the plight of these children and their parents. It is simply outrageous to consider that Ireland's vulnerable children and children in need being ignored due to budget restraints. The importance of early intervention for these children is immense. The younger they are treated, the more chance they have of catching up with their peers and continuing life through mainstream education without a requirement for special needs schooling. By delaying treatment, the Government is increasing the risk that these children will develop additional needs, which will result in a greater cost to the State. This is a matter we can do something about. We can give these children the gift of hearing for relatively little expense. Why can the Government not commit to this? These children deserve to live their lives as their friends do.

I watched the famous debate in which the Taoiseach and the Tánaiste, the presumptive Government at the time, were asked about their number one priority. In terms of social justice, they said the number one priority was disability support. There were promises in the programme for Government and the national disability implementation plan. The Disability Federation of Ireland stated:

The disability movement has been hit hard by harsh outcomes [...], the social infrastructure that exists to support them has been decimated and the initiatives announced today do too little to reverse that. Yet again there has been no commitment from Government to support people with disabilities and their families.

I cannot understand it. The Minister of State and I canvas at election time. In my years in public life, I have never met a voter who said that he or she did not want me to deliver on disability support but wanted me to protect the wealthy and ensure there was no wealth tax for the very wealthy in society. No voter ever asked me to protect the wealthy or to ensure a child who needed a second cochlear implant would not get it.

I never claimed that our party had a monopoly on decency. Deputies and Senators of all political perspectives in this House are thoroughly decent people who have given their lives to public service. What the Government is doing and the policies it is pursuing are indecent. The Minister of State can attend Disability Federation of Ireland events, give a spiel, make commitments in the programme for Government, put in place plans and table amendments to this straightforward and simple Private Members' motion, referring to a new review group and a new clinical care programme, but these political promises will be broken. Who wants it to happen?

Not so long ago, the Minister of State insisted that she had to vote down equality budgeting, even though it is Labour Party policy.

Kathleen Lynch (Cork North Central, Labour)
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It was a disaster and the Deputy knows it.

Pádraig Mac Lochlainn (Donegal North East, Sinn Fein)
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Why do we need equality budgeting? We need it because of the spectacle today, where parents, who are heroes, are in the Gallery advocating for their children. Every parent and every carer for a disabled person is a hero, but we have failed them in politics because we make promises and then they are broken.

Equality budgeting solves that because it ensures that every single budget measure, intervention or new policy from a Department is subject to an equality impact assessment, and the vulnerable who are failed repeatedly by politics are protected by legislation. That is why it is so vital to bring in equality budgeting and protect those who are most vulnerable in society.

The Minister of State is aware that this is wrong. She will make a speech and tell us that the Minister, Deputy Reilly, is conducting a review and they will have a programme and do their best subject to budgetary constraints. Is that what she entered politics for? When she was a much younger woman, with all the progressive ideals that she had at that time, and the equality and fairness for which she stood, did she ever imagine she would find herself in the seat opposite right now having to defend the indefensible? At some point, one must search inside one's self and ask, "How can I stand against equality budgeting?" How can she allow the wealthiest in Irish society to have another celebration? The champagne bottles were probably popping all around Ireland to celebrate because they had been let off the hook again.

That is how one frees up resources. We have shown the Minister of State how she can free up €1.4 billion by asking the very wealthy in Irish society to contribute, yet all we need here is €12 million - she can work out the percentage. It is about choices.

The Minister of State can choose to defend the vulnerable in Irish society. She can choose to protect those who need our support, who have nobody else to protect them and who are failed repeatedly by politics and promises, or she can merely blame it on somebody else. There is no hiding place on this one. There is no big bad troika. There is no big bad Fine Gael. This is a choice. When the Minister of State, Deputy Kathleen Lynch, puts her head down after all her years in politics, puts her head on the pillow and looks back, she will see this was not her greatest moment.

Deputy Lynch should turn this around. She has the power. She is in government. She has a strong bloc of TDs and Senators. She has significant power. She can change this. She has two more years for her legacy. I appeal to her to go back to her roots to find Kathleen Lynch, the younger woman who started this journey, and stand up for the rights of those here. If she can do so I will be a happy man but, more importantly, there are a great many across this State who will celebrate with me. I wish her good luck with that.

Kathleen Lynch (Cork North Central, Labour)
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I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:"- recognises that the 2011 report of the National Audiology Review Group, published by the Health Service Executive (HSE) in 2011, provides the blueprint for the planning, development and delivery of HSE audiology services, including cochlear implantation;

- welcomes the establishment of the National Clinical Care Programme for Audiology which is overseeing the implementation of that report's recommendations;

- notes the recommendation in the report of the National Audiology Review Group regarding universal newborn hearing screening and welcomes the fact that Universal Newborn Hearing Screening is now in place in three out of four regions in the HSE, with roll-out under way in the fourth region;

- notes that since the cochlear implant programme commenced in 1995 in Beaumont Hospital, over 700 patients have received cochlear implants and welcomes the fact that the hospital carried out ninety cochlear implants in 2012 (42 children and 48 adults);

- recognises that the report of the National Audiology Review Group also included a recommendation in regard to funding for simultaneous bilateral cochlear implantation for children;

- notes that initial estimates of the additional resources required for the further development of the service are being examined in relation to the model of care and costings;

- recognises that within the serious resource constraints imposed by the current budgetary and fiscal conditions, the Minister for Health is committed to prioritising quality, safe care for all patients, including children requiring cochlear implants;

- further notes this Government's commitment to the new children's hospital in the Programme for Government;

- commends the Minister for Health on the establishment of the Children's Hospital Group to oversee the integration of three existing paediatric acute services in advance of the new hospital being built; and

- welcomes the establishment of the National Clinical Programme in Paediatrics and Neonatology and the work it is undertaking to develop a model of care for Irish paediatrics to ensure that children get the right care, at the right time, by the right team and in the right place."

We have an enormously difficult budget. Let us be honest about it. It will be a real struggle this year to deliver the types of service we need in terms of what we have available. That all stems from one event, the bank guarantee voted on at 2 o'clock in the morning here, when Members were tired and when the Labour Party pleaded with Sinn Féin not to vote for it. We were told by Sinn Féin's spokesperson that it was a courageous move and to vote for it. The bank guarantee is what has us here. Deputy Mac Lochlainn may not like to hear that, but it is a fact.

The other point I keep hearing about, in particular, from Deputy Mac Lochlainn, is the new politics. However, when I try to practise new politics - I am fairly open about politics and, like the Deputy, do not go in for the party political type at all - Deputy Mac Lochlainn, as he did at the Disability Federation of Ireland event - immediately jumps up and down saying, "U-turn, U-turn." It is not a U-turn; it is being open to change.

We need to get back to the issue at hand, which is about ensuring that young children and their parents have a better shot at life. That is all we ever need and all we ever want, really, for any of our children.

I compliment Happy New Ear. I really do compliment them. I have met them and they are an impressive group of people. I believe they have an argument that is unanswerable. It is an incredible argument. Who, as a parent, would not want it? God knows, each and every one of us who has a child would want that.

The process that needs to take place - I spoke to Deputy Adams in advance of this - was never going to be announced in the budget. That is not how it happens. It needs to be developed and argued in the service plan, and that is what will happen. It is not has if it has not got traction up to this point. The HSE made a priority bid, in terms of both the budget and the service plan process, to the Department of Health in September and had it as a priority issue. I spoke to the Minister for Health before he left the Chamber this morning and said that this was an issue that we had to deal with, and he said it was one of his priorities. We are in there negotiating the service plan to get the best possible result. I am not convinced we will please everyone, but we are in there to get the best possible results. Technology has given these children the opportunity not to be dependent on the State. As someone with responsibility for disabilities, I embrace that because that is something we are trying to do right across the system.

Screening of newborns will ensure that difficulties are picked up at a much earlier age. Approximately 94 cases per year are being diagnosed now. If we insist on newborn screening and we have the technology and the ability - I am not certain about the funding, which I am not promising and which I did not promise to the group when I met them because I, unlike others, for the information of Deputy Martin Ferris, do not promise what I cannot deliver-----

Martin Ferris (Kerry North-West Limerick, Sinn Fein)
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The Minister of State's party did.

Kathleen Lynch (Cork North Central, Labour)
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I do not promise what I cannot deliver. What I am saying is that if we have the technology and if all we need is the money, we will argue that.

As Deputy Adams correctly stated, because it was a conversation we were having, this does not need the €12 million up front. We will have to build a team. That team has to be put in place because it will require additional resources but also manpower. However, we have an expert in the field, a consultant in ear, nose and throat medicine, ENT. I am glad to say the consultant is a woman, an extremely impressive woman. Therefore, we are doing our best.

It is not something we dismiss, but it is something that must be part of the process. We cannot say, until we come out the other end of that process, whether we will be able to do it entirely. It would be my fervent hope that we can and it is something for which we will be arguing strongly.

For those who are less familiar with bilateral cochlear implants, it is important to explain what a cochlear implant is. I definitely do not need to explain it to the parents in the Gallery. It is a highly sophisticated device which provides access to sound for those with severe to profound hearing loss. The surgically implanted device, as was explained to me, when coupled to an external processor, can provide access to speech and everyday sounds to aid or improve communication abilities. It is not only about listening to music, although I acknowledge the joy of that. It is not only about that; it is also a safety issue, as parents need to be able to stop their children from running onto the street or doing something that is a danger to them.

The routine practice in Ireland so far has been to implant one side only. The selection of the ear to implant depends on clinical factors. However, it is now considered best practice worldwide that children should have bilateral implants. I am aware that in Britain, the 2009 National Institute for Health and Clinical Excellence guidelines advocated that it was best practice that all children should have bilateral simultaneous implants.

I will tell Deputy Mac Lochlainn about the national review, because it is important. The parents contributed, as did the ENT consultant and all of the experts. Whatever we do in this Government, it cannot be similar to what previous Governments did, as it must be evidence-based. These aspects are important. That view was supported by the national review of audiology services which was carried out by the HSE. The aim of the review was to examine the services provided to children and adults nationwide and to formulate a national plan for the services - just as we are doing in mental health, where we are clearly not there yet and where significant investment is needed. It should not depend on one's postcode whether one's child gets this service, and that is why national clinical programmes are important. The report of the review was published by the HSE in 2011 and provides the blueprint for the planning, development and delivery of HSE audiology services.

I want to particularly note that the audiology review group found considerable evidence of patient and parent satisfaction with the National Cochlear Implant Centre at Beaumont. I commend the excellent people involved in the cochlear implant programme. The audiology review report recommended continued ring-fenced support for the cochlear implant programme but at levels which allow for simultaneous bilateral implantation for children. It also supported the proposal to locate the national paediatric cochlear implant service within the new children's hospital. It recommended that the paediatric cochlear implant team should be integrated with the paediatric audiology service at the new children's hospital. In this context, I would note that while Beaumont Hospital is the national centre, currently, surgical provision for the under-sixes takes place at Temple Street. Since the report of the audiology review group was published, the HSE has established a national clinical care programme for audiology which is overseeing the implementation of its recommendations. A new national clinical lead was appointed earlier this year and four assistant leads are to be appointed shortly. Under the auspices of the clinical programme, progress is being made in the modernisation of audiology services in Ireland. A total of €3.7 million was made available in 2011 to begin the implementation of the recommendations and an additional €1.9 million was made available in 2013.

One of the main recommendations in the report includes the national roll-out of a universal newborn hearing screening programme. This is a key priority to ensure that all babies have their hearing screened shortly after birth. I greatly welcome the fact that universal newborn hearing screening is in place in HSE south, HSE Dublin-mid Leinster and HSE Dublin north east. HSE west is in the final stages of going live, with only Limerick hospital remaining to go live before the end of the year. From April 2011 to the end of July 2013, 62,000 babies have been screened and 94 cases of permanent childhood hearing impairment have been identified. If it is being identified at this very early age then the natural next step must be to deal with the issue when it can be dealt with. I am no great expert in this area. I only know what the parents and the consultant told me. However, it is the case that some children will not be able to benefit from this programme. The numbers are not overwhelming. The diagnosed figures are not overwhelming. The Government has managed to achieve certain things, albeit with very scarce resources, which should have been done when the country was awash with money. It is a matter of us all co-operating and ensuring that we do the right thing.

Gerry Adams (Louth, Sinn Fein)
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Hear, hear.

Kathleen Lynch (Cork North Central, Labour)
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Five front-line audiology staff are currently being recruited to support the newborn hearing screening programme. There will be a further recruitment process later in 2013 for two to three additional posts. In addition, ten students who received the MSc in audiology with HSE sponsorship have been offered appointments. We are building up the team. Another key recommendation was the establishment of a bone anchored hearing aid programme or BAHA. It recommended ring-fenced support for the programme which has now commenced in six hospital sites. In addition, recognising the importance of accurate and timely waiting list and activity information for audiology services, the programme has recently developed a waiting list and validation procedure to be implemented nationally. It is a case of ensuring that those who need the help get it and that we are dealing with the right cohort of people. I am very pleased with the progress to date in implementing the recommendations of the HSE review, with the universal newborn hearing screening programme being a particular success. The business case for bilateral cochlear implantation was put together by Beaumont Hospital and the HSE in 2013. The HSE has been working closely with Beaumont Hospital to progress plans for bilateral cochlear implantation. The business plan is a tool to be used in the programme. Such a programme will involve the assessment, fitting and post-operative follow-up of simultaneous cochlear implants. The business case outlines estimated resource requirements for the introduction of simultaneous bilateral cochlear implantation. The business case also addresses how sequential second implants could be provided to the cohort of children who have received one implant and who are assessed as suitable for a second. It sets out a number of options for how sequential implantation may be managed. The consultant ENT surgeon made a very strong case in this regard and he emphasised that the team must be built up. This is a complex development and the HSE has engaged with many stakeholders in the proposal development. It has also engaged the support and advice of two UK experts in the development of the business case.

The introduction of a bilateral cochlear implant programme clearly has cost implications. Estimated costs have been developed and these are now being examined closely and are subject to further review. The resources required for the introduction of bilateral cochlear implantation will have to be considered in the context of the health Estimate for next year which was announced on Tuesday. In developing its national service plan on the basis of Tuesday's budget, the HSE will have to consider the exact type and quantum of services to be provided. This must be done in the context of the over-riding priority of the Minister for Health, Deputy Reilly - which I share - for quality and patient safety. Quality, safe care for children means that wherever our children live, and whatever their diagnosis, the health care they receive must be of a consistent quality and standard. A clinical programme is under development. This is a priority issue which will be dealt with in the service plan.

I think this motion would have been more effectively tabled once the service plan was published. I am someone who does not practise party politics to a great extent, much to the disdain of my party colleagues from time to time. We need to see what can be done in the context of the Estimates and the service plan. This is a particularly difficult year. It is not the case that the Government is unsympathetic but as my sister-in-law says, "What pocket does that go into?" Sympathy is all well and good. I assure the House that the Minister and I regard this issue as a priority and we are fighting our corner on it. I hope people accept our good faith because it is the truth.

Seán Kenny (Dublin North East, Labour)
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The next speaker is Deputy Joe O'Reilly, to be followed in the time slot by Deputy Fitzpatrick.

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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I welcome the motion and I commend Sinn Féin on raising this important issue. It beats some of the nonsense, grandstanding type of Private Members' motions that have been tabled over the year. I hope that in tabling this motion Sinn Féin will be prepared in its response to accept the bona fides of the Minister of State, her commitment to dealing with the question and her acceptance of the broad issues raised. A sensible approach in the House will progress important social issues such as this which are truly above politics and which merit addressing in the most sincere and proper way.

Two to four persons in every thousand of the population have permanent childhood hearing impairment. This is a high number of individuals. I have a great personal interest in this topic.

As one of the families with which I have been great friends throughout my adult life has been severely affected by this issue, I have a personal interest in it from that perspective. It is also a matter that could have an impact on any of us in this House.

Conventional wisdom and the accepted best advice are that a bilateral cochlear implant is the way to proceed in a case of permanent hearing impairment in a young child; therefore, we should move to achieve this as quickly as possible. That should be made clear at the outset and I am firmly of that view; therefore, it is only a question of deciding on the methodology to be used and allocating funding. It is worth indicating the services that are provided free. There is free screening, assessment, investigation and treatment, while devices are provided. Speech and language therapy is also provided and there are visiting teachers from the deaf services. It is only proper that these services are in place. Since 1995 in Beaumont Hospital there have been 700 cochlear implants, of which 90 were carried out in 2012. Of these, 42 were provided for children and 48 for adults.

An important document was alluded to by the Minister of State and we cannot progress without referencing it, despite Deputy Pádraig Mac Lochlainn's remarks. It must be our benchmark and reference point. I refer to the 2011 report of the national audiology review group. It provides a blueprint and makes the following main recommendations. It argues that there should be universal screening for newborns. This is place in three HSE areas and the service will be rolled out in the fourth. The continuation and development of the programme are very significant achievements by the Administration. Some €3.7 million was made available in 2011 to begin implementation of the review group's recommendations, while €1.9 million was made available in 2013. These are tangible achievements and although it may be unpleasant to reference it, the investment is happening at a time when we are-----

Luke Flanagan (Roscommon-South Leitrim, Independent)
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Writing down Denis O'Brien's loans.

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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-----spending €1 billion a month more than is being made and our overall borrowing figure relative to national wealth is in a perilous position. In that context, these achievements and this level of investment - €3.7 million in 2011 and €1.9 million in 2013 - are not insignificant. They suggest prioritisation of people who need this service, which is only right. As the Minister of State indicated, there are ten students being sponsored by the HSE to pursue in the United Kingdom a master's degree in audiology and they will shortly be assigned to work here, which will greatly augment the service available. A procurement exercise for the purchase of hearing aids, fitting systems and audiological assessment equipment has been completed, which is also important.

The 2011 audiology review recommends continued ring-fenced support for the cochlear implant programme but at levels which would allow for simultaneous bilateral implantation for children. In other words, it is accepted that this is the way to go. We do not have a dedicated programme and the Minister of State has indicated it is being developed in the context of the national service plan and will be in place shortly. However, some bilateral implantations have occurred for patients, mainly young children with certain medical conditions such as meningitis and blindness. They have already had bilateral cochlear implants, meaning there is a precedent, but we must broaden the process.

There are two aspects to developing the programme. There is simultaneous cochlear implantation for new cases, with the provision, where clinically appropriate, of bilateral cochlear implants at the same time. Even to a lay person, the process of doing both ears in one surgical procedure makes sense and I support it as both logical and humane. The other option involves a sequential process, where people have already had a cochlear implant and must be reassessed before getting a second. That would also have to be part of the programme.

A business case for bilateral implants was developed with Beaumont Hospital and the HSE developed it in liaison with the hospital. Such a programme would involve assessment, fitting and post-operative follow-up of simultaneous cochlear implants. The business case also addresses how sequential second implants could be provided for the cohort of children who have received one implant and are assessed as suitable for a second. This is a complex development and the HSE has engaged with many stakeholders. It has also sought the support and advice of two UK experts in the development of the business case which outlines estimated requirements for the introduction of simultaneous bilateral cochlear implantation and sets out a number of options for how sequential implantation may be managed. The programme will involve additional staff, equipment and capital works and be contingent on additional funding. Estimates for the full cost of introducing a bilateral cochlear implantation programme for children are €2.38 million. This figure encompasses extra staff and non-pay costs. The cost of providing a second implant for children who already have one is €3.5 million to €10.2 million. The Minister of State committed to working to achieve this and finding the money somewhere. Everything about the Government's record to date in this area follows on from this. I am personally very committed to the cause and urge both the Minister and the Minister of State to work together to get the programme in place as an absolute priority.

I join in the congratulations to and lauding of the Happy New Ear lobby group, although I have not met its members because I was away when they were in Leinster House meeting people. We should stand in awe of such individuals and have nothing but respect for them as face this issue every day. I am privileged to be a parent and have a background in primary teaching and both of these aspects give me an acute appreciation of how important this issue is. I am unequivocally in favour of the bilateral cochlear implants issue being progressed and the work being done by the Government to achieve this objective. I commend the Minister and hope he will keep up the pressure. I appeal to Sinn Féin to be true to the cause it advocates by accepting the bona fides of the Government and accepting our position. We must work together to achieve quick implementation of this programme.

Peter Fitzpatrick (Louth, Fine Gael)
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A cochlear implant is a highly sophisticated device which provides access to sound for people with severe to profound hearing loss. The surgical implant device, when coupled with an external processor, can provide access to speech and everyday sound to aid or improve communication ability. Beaumont Hospital is the centre for the delivery of Ireland's national cochlear implant programme, but surgical procedures for patients under six are carried out at the Children's University Hospital at Temple Street. Since the programme commenced 17 years ago, more than 700 patients have received cochlear implants.

There are two aspects to the introduction of a bilateral cochlear implant programme. Simultaneous cochlear implantation is the provision of clinically appropriate bilateral cochlear implants at the same time as a single surgical procedure. Sequential cochlear implantation is the provision of bilateral implants separately, over a period of time. With the introduction of a bilateral cochlear implantation programme, children who have already received one implant under the national cochlear implant programme will need to be assessed for candidacy for a potential second implant, and be provided with information about the advantages and disadvantages of a second implant. The full-year cost of introducing simultaneous bilateral cochlear implantation for children has been estimated at €2.38 million. This estimate encompasses estimated additional staffing needs and additional non-pay costs. In addition, there would be some capital costs associated with the expansion or enhancement of infrastructure, initially estimated at €1 million.

There are a number of possible options with regard to the implementation of sequential bilateral cochlear implants for the cohort of children who already have one implant. The cost of providing a second implant in this cohort is estimated to vary from €3.5 million to €10.2 million over the period of implantation, depending on the option chosen. It is also important to note that it is not possible to be definitive about the level of uptake of a second sequential implant among this cohort.

A national clinical care programme for audiology has been put in place under the clinical strategy and programmes directorate. A new national clinical head commenced in March 2013 and a panel of successful candidates was created to fill four new assistant head posts.

Permanent childhood hearing loss occurs at a rate of two to four per 1,000. Children are entitled to HSE audiology services free of charge, including screening, investigation, treatment, rehabilitation and devices, speech and language therapy and referral of children with a hearing loss to a visiting teacher of the deaf services under the Department of Education and Skills. In April 2011 the HSE national audiology review group published a report that identified some inconsistencies and shortcomings in audiology services throughout the country, including access issues, poor information, inadequate staffing levels, poor infrastructure and unacceptable waiting times. It made recommendations for addressing these issues. Audiology services require restructuring to place audiologists into fewer teams with larger clinical mass in order to deliver better clinical governance and efficient care pathways. Some work has been initiated in this area, with €3.7 million being made available in 2011 to begin implementation of the recommendations of the review group. An additional €1.9 million was made available in 2013.

Seán Kenny (Dublin North East, Labour)
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The Deputy must conclude.

Peter Fitzpatrick (Louth, Fine Gael)
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Universal newborn hearing screening, UNHS, is in place in the HSE south, Dublin mid-Leinster and Dublin north east regions. HSE west has been going live throughout 2013, with UNHS already rolled out in Letterkenny and at Sligo General Hospital. Front-line audiology staff are currently being recruited to support the newborn hearing screening programme. A procurement exercise for the purchasing of hearing aid and fitting systems and audiological assessment equipment has been completed.

Seán Kenny (Dublin North East, Labour)
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The Deputy is well over time.

Peter Fitzpatrick (Louth, Fine Gael)
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A memorandum of understanding has been developed between Deafhear, HSE audiology, HSE speech and language therapy, the Beaumont Hospital cochlear implant team and visiting teacher services to ensure that all groups are working together to provide services to people with hearing impairment.

Billy Kelleher (Cork North Central, Fianna Fail)
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I wish to share my time with Deputy Robert Troy.

I put on record my party's appreciation of Deputy Adams for tabling this important motion on Private Members' business. This issue has been discussed in the House on a number of occasions and we will be glad to support the motion. The health committee is considering the issue simultaneously and some of the Members who will contribute are attending the committee. It will be worth people's while to stay for the full debate.

The ongoing Happy New Ear campaign has continued for a very simple reason. Empirical evidence exists to show that if they have a bilateral cochlear implant affected children can reach a fuller potential; that is why parents are campaigning on this issue. The longer it takes to implement the programme to be put in place in Beaumont Hospital, the more children there will be who will not be able to reach their full potential. The key issue is time. We must ensure there is a rapid move to address the situation of children who have been given a single cochlear implant, especially those who are reaching the time when a sequential cochlear implant will no longer be beneficial. Time is of the essence. Whatever resources are made available, I urge that there be an acknowledgement that an assessment of those who immediately need such an implant must be done so that we do not allow them to slip into a life in which they are not able to hear as well as they might if they had received the second cochlear implant in good time. For all these reasons, this is an urgent issue.

The Minister for Health, Deputy Reilly, announced last week that a proposal was being developed by the HSE in conjunction with Beaumont Hospital to roll out this plan. Capital funding is required, along with funding for extra staff and resources, to put the plan in place. I would be slow to congratulate or condemn anybody in this regard, but the reason the motion was tabled is that it is urgent. As we speak, the HSE is drafting its national service plan for 2014. If this programme is not included in that plan within the coming weeks, we will be back in this Chamber again next year and a cohort of children will not have been given the opportunity to reach and maximise their full potential. We talk about cherishing children equally, about universal entitlement and about ensuring that those who are vulnerable are supported. Here is a cohort of people for whom we could do a very great deal with small resources in the overall context of the benefit this procedure would have on their quality of life for the rest of their lives. Time is significant and this is very important.

Some 200 children would benefit from such a programme. Their parents have campaigned in a dignified manner throughout. They are the ones who know full well that evidence exists, nationally and internationally, to show that those children who receive simultaneous cochlear implants develop more quickly and to a fuller potential than those who receive a single implant. Beaumont Hospital has done tremendous work and its new consultant in this area is promoting this plan. We in this House must be honest, however, and point out that good sentiments, support and nice words must be aided with finance. Things are scarce and it is a difficult time, but we cannot deny these children the fundamental right to which they are entitled. We must urgently press for action.

The Sinn Féin motion proposed by Deputy Adams is exceptionally timely. We met the group Happy New Ear in an all-party approach and have been in contact with the HSE. I raised the matter in a Topical Issue debate in June. The business plan is to be submitted to the national service plan of the HSE, but that has to happen in the coming weeks. That is the reason this motion must be supported on all sides of the House and why there must be a meaningful input on the part of the Department and the HSE in terms of resourcing the plan. I urge the Minister to take this on board. I know there has been strong commitment verbally, with tacit support on the Government side for the programme, but it is critical that we do not deny and delay further the implementation of a bilateral cochlear implant programme. We must then immediately start to provide sequential implants, as there are children coming to the age at which it will no longer be of benefit to them to have a second implant - it will be too late for them when they reach the age of five, six or seven years. It must be terrible for parents to watch time slip away and see their child not being able to develop to his or her fullest potential as he or she is entitled to under every basic tenet of decency we advocate in this House when we talk about giving everybody the opportunity to develop their full potential.

I commend and endorse the motion. We were very glad to support it when Deputy Adams asked us to put our names to it. That is an unusual departure, but as a political party we were delighted to do this. I urge the Government to come forward quickly with a commitment to write this programme into the service plan for 2013. When we met the parents involved and the Happy New Ear people they were very understanding about the financial difficulties for the Government.

The group accepted that nothing could be done in 2013 because the service plan had already been drafted and that it must wait until 2014. The members of the group were willing to wait until 2014, knowing that the longer they wait the less impact the implants would have on some children. That is an indication of the dignified approach of the group on the issue. Such dignity should be reciprocated with a financial commitment to ensure that at the very least those who are coming to a certain stage in their childhood development would get a second cochlear implant to allow them to reach their full potential. I commend the motion and urge the Government to insist that next year’s service plan make provision for bilateral cochlear implants and the full roll-out of the Beaumont audiology service.

Robert Troy (Longford-Westmeath, Fianna Fail)
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I welcome the opportunity to contribute to this extremely important debate on what is, as my colleague has just outlined, such a time sensitive issue. I am happy to support the motion and I compliment Sinn Féin on introducing it and ensuring there is a cross-party debate. I compliment the families involved in the Happy New Ear campaign who have ensured this item has been kept on the political agenda. The issue came to my attention last year while out knocking on doors in Mullingar. I met Lorraine Murphy of the Happy New Ear campaign who explained articulately to me the issue that affects her daughter and many other children in the country. She said that in April the implant her four year old daughter Anna had received two years previously failed and she was left in silence for five weeks, during which she was confused, frustrated and upset. If she had had two implants she would have had a backup. More important, there was a chance that following the re-implant she would have to learn her sounds from scratch again. The family did not know until after the operation whether that would be the case. The possibility was that every word Anna had learned to understand after many hours of work could be lost following the failure of the implant, which caused great anxiety and worry to the family. Luckily, that was not the case and Anna quickly remembered all her sounds. There would not have been any need for such concern if two implants had been inserted on day one.

The families are to be commended. They lobbied Deputies across all political parties and, at my request, appeared before the Oireachtas Joint Committee on Health and Children. To be fair to the Minister, he met with a delegation, at which point he gave hope that the issue would be addressed as part of budget 2014 and included in the service plan. My colleague, Deputy Kelleher, outlined how understanding the group has been. It acknowledged that the Minister could not deal with the issue midway through 2013. I am at a loss to understand why the Government has tabled an amendment to the Private Members' motion, instead of accepting it, making the resources available and outlining a clear and definitive timeframe for the implementation of a new cochlear implant policy. All international evidence suggests that children who are profoundly deaf have a considerable advantage if they receive two cochlear implants instead of one.

I wish to read into the record the benefits of bilateral implants as outlined in research carried out by St. Louis Children's Hospital, one of the premier children's hospitals in the world.

Listening with two ears: This is an important listening mode which makes it easier for speech from both sides of the head to be heard and processed by the brain.

Hearing in noise: Hearing with two ears allows us the remarkable ability to “tune in” to someone we are trying to hear and understand when we are surrounded by background noise, which is usually the sound of other people talking!

Localization: Hearing with two ears is essential for humans and animals in identifying the direction of sounds. The ability to localize sounds has obvious safety implications for a child or adult in that he/she could hear someone calling out a warning or being able to tell from which direction a car is coming while crossing the street.

Binaural hearing offers more natural, balanced sound and can improve the “ease of listening” in the same way that vision in both eyes eases and improves the ability to see. When there is hearing only in one ear, there are many challenging situations that can be frustrating. This frustration often leads to eventual social isolation, resulting in a poorer quality of life. Research study subjects using bilateral hearing aids typically report sound to be clearer, fuller, more natural, and more balanced.

Finian McGrath (Dublin North Central, Independent)
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Hear, hear.

Robert Troy (Longford-Westmeath, Fianna Fail)
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The past three budgets were regressive and targeted the sick, the vulnerable, those less well-off and those who were disproportionately unable to take any hits. If the Government had thought about introducing a 3% levy on the universal social charge for those earning more than €100,000 it would have yielded €170 million. Such a proposal was once advocated by the Labour Party. If the Government had introduced a lid levy on the off-licence trade it would have yielded €150 million in one year. Let us consider the protection that such funding could have offered to the disability sector.

I am disappointed to hear the Minister of State, Deputy Kathleen Lynch, state that the Department will negotiate with the HSE. How many times have we heard the Minister for Health, Deputy Reilly, say he was a hands-on Minister? Staff in Beaumont Hospital are willing and eager to carry out bilateral cochlear implants. They cannot do it without resources. The sum of €18 million which is required to ensure the introduction of bilateral cochlear implants should be forthcoming from the Government in order to give the children that are affected the best start in life. That would reduce the need for special needs assistants and ensure the children could reach their full potential. Such a step would allow us to live up to our constitutional commitment to cherish all the children of the nation equally.

Clare Daly (Dublin North, Socialist Party)
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I wish to share time with Deputies Mick Wallace, Luke 'Ming' Flanagan, Finian McGrath, Catherine Murphy, Maureen O'Sullivan, John Halligan and Mattie McGrath.

Joe O'Reilly (Cavan-Monaghan, Fine Gael)
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Is that agreed? Agreed.

Clare Daly (Dublin North, Socialist Party)
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It is almost unbelievable for two reasons that we are having today’s debate. First, because there are so few children affected by the measure and, second, because the procedure under discussion is life-altering and is also time-restricted. It is criminal that parents have had to turn themselves into full-time campaigners. I welcome their initiative. I recognise that their drive has resulted in our providing time to discuss the issue today. It is not the first time that the members of the group are in the House. They met with the HSE in March and May. They worked out a plan along with Beaumont Hospital so that they would be ready for this year’s budget. They met with the Minister of State, Deputy Kathleen Lynch, in May and they attended a meeting of the Joint Committee on Health and Children before the summer.

Everybody was sympathetic and listening, but the Government has turned around again today and stated that while this is a priority, it will deal with it as a project plan. The information has been given in the House that the children in question have a very short window of opportunity to access the treatment that is the norm in other societies. If the nerve is not stimulated within a certain period, it will die. Time is critical and project plans are not what is needed. The affected individuals need the system that has been devised to be put in place. There is no excuse for not doing so.

We have talked about vast sums of money in the past few days. Implementing the programme requires a capital investment of €7 million and an annual fee of €4 million in the early days. Coincidentally, this is the equivalent of the amount we waste putting poison, fluoride, into the water supply. The Government could have a win–win set of circumstances in which it could fund the implants for free and transform the lives of the children concerned at no cost to the Exchequer. There is no excuse for further delay.

Mick Wallace (Wexford, Independent)
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Time is short and I will use mine to read a story, an extract from an article in the Donegal News. It reads:

Alison and John's daughter Taylor … was diagnosed as being profoundly deaf when she was 19 months old.

Alison said: "We were referred to Beaumont Hospital which runs the National Cochlear Implant Programme. After months of tests and appointments she was finally accepted onto the programme and was fitted with a Cochlear implant on November 1, 2012.

"After three weeks of healing we returned to Beaumont for the implant to be 'switched on' which would allow her to hear for the first time.

"This was an extremely emotional day for us as we realised our baby had never heard us tell how much we love her up until this point."

The couple said they were told they had to start from the very beginning as their daughter was behind in terms of speech development due to her hearing condition.

"It has been just under three months since Taylor joined us in this hearing world and the changes in her have been amazing.

"She has started to babble 'Mama' and 'Baba', the way any young baby would start off - these being words we thought we may never hear. She is also turning whenever we call her name, truly a miracle," said Alison.

"As Taylor only has an implant on one side, [however,] her brain is so exhausted in the evenings as it's being overworked trying to take in all this information through one ear."

[A] second implant would allow little Taylor to progress at a much faster pace and more chance of being on level par with her peers at school ...

Luke Flanagan (Roscommon-South Leitrim, Independent)
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I commend Sinn Féin not only on its tabling of this motion but also on following up on this issue time and again and not letting it go. If one found a cure for cancer, Parkinson's disease, multiple sclerosis, blindness or some people’s deafness, as many others and I have often imagined, it would be an absolutely brilliant day. Now that that brilliant day has come for many people who suffer from deafness, the Government seems to think it is bad and some sort of burden. If a cure for blindness was found in the morning, I imagine the Government's reaction would be to ask how it would fund it. It would be bad news for the Government.

Everybody talks about the numerous choices that must be made, including all of the tough choices the Government must make. I include the choice with regard to the €2 billion in tax relief on pensions for the most wealthy 20% in the country. The Government could have spent some of the money on cochlear implants, but it made the choice to ignore the people affected. It chose to spend the State's money on subsidising Independent News & Media by writing down its debts. It made the choice to subsidise a billionaire who did not even pay his tax in this country instead of helping children who could hear if they were helped. There is no need to imagine any more that there is a cure because there is, but the problem is that we live in a country in which the Government does not care enough to do anything about it. There are none so deaf as those that will not hear.

Finian McGrath (Dublin North Central, Independent)
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I thank the Ceann Comhairle for giving me the opportunity to speak on this urgent motion on the 200 children who need cochlear implants. I will be voting for it and supporting the children concerned and their families. The motion is about the health of the children but also about caring for their future. If one examines the details, one cannot sit on the fence. I urge the Government to consider the motion seriously and support the families in question.

International best practice in treating children who are profoundly deaf is to provide bilateral cochlear implants. Children in the State who are profoundly deaf are provided with only one implant. The absence of a second implant creates problems for the children in discerning speech in noisy environments. It is a race against time because the nerves to which implants are connected become more redundant every day and eventually die if they are not used. Unless implants are connected in the earlier years - that is, at the age of seven or eight years - it is accepted that the operation will be ineffective. That is the reality for the children concerned and their families.

For me, the provision of cochlear implants is a human rights issue. As said by a number of my colleagues, the estimated cost is in the region of €12.8 million. How dare the Government moan in the House about €12.8 million when it spent €14 million some Fridays ago on a referendum that nobody was really behind. The Government spent €14 million and now it cannot find €12.8 million.

The sterling work being done on this issue in Beaumont Hospital in my constituency is very important. Today I call on the Government to ensure the proposed business plan by the HSE and Beaumont Hospital to introduce a bilateral cochlear implant programme is contained in the budget for 2014 and part of the HSE Estimates process for 2014. The children who are profoundly deaf should receive the most effective care possible according to international best practice. I urge all Deputies to support the motion.

Catherine Murphy (Kildare North, Independent)
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I thank Sinn Féin for tabling this motion and I am very happy to be associated with it. I wish to read a response I received from Beaumont Hospital to representations about a patient. The case concerns an adult with hearing loss due to a virus. The clinic is the same as that used for the children in question. The adult is a lone parent with a child with special needs. The kind of response that applies is very similar, irrespective of whether a child or an adult is involved. Those responsible for the national cochlear implant programme wrote to me stating:

The team understands and appreciates the significant difficulties those with bilateral profound hearing loss have, especially with limited access to speech using high powered hearing aids and little to no lip-reading skills [which clearly children will not have] ... Unfortunately, this is a very common thread among those currently under assessment for a cochlear implant. Ideally, the CI team would like to limit the time from initial clinic assessment to cochlear implant surgery in order to provide rapid quality service to those people on this programme. However, given current constraints, including finances, theatre time, testing facilities, and staffing levels, the team is not able to achieve this goal. As this is a strictly publicly funded service we work within the means available to deliver a multidisciplinary service as best we can to those under assessment and the 700+ currently implanted CI users who are under this programme's care.

Maureen O'Sullivan (Dublin Central, Independent)
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My first contact with the deaf community was through students of mine whose parents were profoundly deaf. That brought me into the deaf club which was then located at the top of Clonliffe Road. I have been to Deaf Village Ireland on Ratoath Road many times and I am well aware of the facilities and services available there.

I support equality of treatment for the deaf community. The 2009 NICE guideline for best practice, in line with international best practice, was to provide a profoundly deaf child with two cochlear implants. It is hard to see why this is not happening, especially when there is a time limit on when a cochlear implant can be successful.

The benefits to those children receiving two implants are well researched and documented. On a practical level, if a child has one implant but there is a problem with it and it has to be taken out, the consequences for the child are very severe in that he or she is left totally deaf for that time. Simultaneous implantation is the most efficient way forward, with both ears implanted in one surgical procedure. It is also cost effective to do so. Research indicates that bilaterally implanted children catch up with their hearing peers in terms of speech, language and communication skills much faster than unilaterally implanted children. They also do not need the same level of speech and language support and resource teaching as those children with only one implant.

The introduction and roll out of the national neonatal hearing screening programme means that deaf children are presenting earlier, which is a huge step forward. Providing two cochlear implants to these children would finish that work. I listened to the Minister this morning talking about the bank guarantee and what we have to pay. It is completely immoral and unethical for her to say that this is a Government priority and €12 million for deaf children is not. We saw what was spent on the Seanad referendum, which was totally unnecessary.

Finally, I wish to acknowledge the campaign to have Irish Sign Language recognised as the third indigenous language of this country because that is the language of so many deaf people.

John Halligan (Waterford, Independent)
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There is a famous clip on YouTube featuring an eight-month old deaf baby's reaction to a cochlear implant being activated. In the clip, the boy's mother is holding him as his ear implant is activated and when she says hello to him, he flashes his mother a huge smile. To watch both the child's and the mother's reaction as he hears sound for the first time is truly humbling. That clip was recorded in 2008 and has been viewed by millions of people all over the world. It is such a wonderful example of medical science to see it in action. I urge all Government Deputies today to go back to their offices, turn on their computers, watch that clip and then come back and make a decision as to how they will vote on this motion.

The current long waiting time for cochlear implantation means that Irish children and their parents are missing out on something that many of us take for granted - speaking time. These children suffered a random natural injury that puts limitations on their lives but medical science came up with a solution. It is horrifying that the State places more emphasis on bailing out bankers and bondholders than it does on giving hearing back to Irish children.

Hearing impairment has a significant impact on language development. Scientists have pointed out that there is a sensitive period during which language develops. This period should coincide with the implantation of two cochlear implants to maximise a child's ability to acquire language. This was brought to the attention of the House a few months ago by the leader of Sinn Féin, Deputy Adams. At that time, the Taoiseach made all sorts of complimentary remarks about Beaumont Hospital. He spoke about how sad it was that this was happening and how something should be done about it. Deputy Flanagan spoke about people who are blind but if we found a cure for blindness, would we seriously say to people, "We have a cure but we will only put the sight back in one eye?" It is outrageous. What the Government is doing is appalling and it is very offensive to the families of children who are affected by this condition.

Mattie McGrath (Tipperary South, Independent)
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A lot of valid points have been made and I compliment the movers of this motion. There are 200 children in need of this wonderful and exciting solution to their medical problem. It is a wonder of medical science. It is a pity that the Minister for Health or a Minister of State in his Department is not here to listen but I ask the Minister of State who is here, Deputy Fergus O'Dowd, to urge his colleagues to show some humanity. They must understand that it should not always be about showing the white flag and licking up to the troika. We must look after the personal needs of a small number of children. We must give them the chance and an equal opportunity to live their lives to the full. They must be given these implants soon because there is only a certain amount of time during which implantation is successful. The fact that the State is currently only providing one implant to these children is shameful. This will cost €12 million but the Government wasted €14 million on a pet project, an ego-trip for the Taoiseach. I urge the Taoiseach to come off his high horse, eat some humble pie, listen to the people and show some humanity and common decency. He should provide funding for this miraculous treatment for these very young people.

Marcella Corcoran Kennedy (Laois-Offaly, Fine Gael)
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I wish to share time with Deputies Ann Phelan, Eamonn Maloney and Gerald Nash.

I welcome the opportunity to speak on this important motion. I first became aware of the need for bilateral cochlear implants for severely or profoundly deaf children, particularly those under five, when a parent in Offaly contacted me last March. She invited me to meet the newly-formed Happy New Ear lobby group, which I was delighted to do and we discussed the issues involved. Since then I have been in regular contact with the Minister for Health, Deputy Reilly, and the Minister of State, Deputy Lynch, and on all occasions have received very positive responses from them. Indeed, they met the group on several occasions this year, most recently in July. I wish to acknowledge the work done by the Happy New Ear group in assisting HSE personnel in the development and planning of the business case proposal to introduce a bilateral cochlear implant programme in Ireland. I know as a parent that when one has a child with special needs, one's focus is totally on that child. For the parents of these children to be able to come together as a group is commendable and I congratulate them for their efforts.

While I know there is naturally a degree of impatience, tremendous progress has been made this year. The group must also be acknowledged for the work it has done in enlightening us all. When one has a family that does not have these needs, one's focus is in a totally different direction. The work the group has done in enlightening us all must be commended.

In 2009, the UK National Institute for Health and Clinical Excellence recommended simultaneous bilateral cochlear implantation for children. The institute was clear in defining the urgency and essential nature of this surgery. It is well known that the surgery is most successful when carried out on children under five because the brain interprets sound more effectively in the first few years of life. There is worldwide evidence showing that the surgery is most suitable and effective for children who are born deaf or whose hearing has deteriorated to the level of being profoundly or severely deaf. As with all surgery, there are risks but the outcomes are marvellous. For example, children's listening skills improve for many years, their speech and language development is greatly improved and most important of all, the sense of isolation that those who have hearing difficulties experience is greatly reduced. The children are able to hear for the first time and live with the benefits of that, which all of us who have been blessed with hearing can appreciate. We can only imagine how restricted life is for those with hearing problems.

Since the national audiology review group reported in 2011, there is now a clear blueprint for the delivery of all audiology services, including cochlear implantation. The group's report has a recommendation for funding simultaneous bilateral cochlear implantation for children. I am glad to note that the national clinical care programme for audiology has been established and that newborn hearing screening is now in place in all but one HSE region. The roll out of the screening programme will be completed this year. Currently recruitment of audiology staff is taking place, which I welcome. I also welcome the fact that the HSE has sponsored ten students to pursue a master's degree in audiology in the UK. The lack of specialists in this field was highlighted by Ms Laura Viani, the ENT surgeon and head of the department of audiology at Beaumont Hospital at a presentation I attended recently. She made the point that this is not something that has only been highlighted this year. In fact, she has been campaigning for this for many years and finally, this year, attention is being paid to it.

It is important to note that the HSE's audiology services are free of charge. However, there were shortcomings in the service and the Happy New Ear group has worked closely with the HSE to improve the service. It has made recommendations on restructuring the service and these will definitely result in a better service for patients. One of the most welcome developments in the ongoing efforts of the Department and the HSE is the signing of the memorandum of understanding between DeafHear, HSE audiology, HSE speech and language therapy, Beaumont cochlear implant team and the visiting teacher service so that a much more cohesive service can be provided to those children who need it.

Up to six hospitals, including Tullamore hospital, have commenced the bone anchoring hearing aid programme for both adult and paediatric cases.

The Government’s commitment to children is clearly outlined by the fact that for the first time ever there is a full-time Minister for Children and Youth Affairs at Cabinet. The new children’s hospital is a priority for the Government with €450 million in funding allocated from the Exchequer and €200 million coming from the sale of the national lottery. The sooner we see progress in its construction, the better.

I hate when one has to make a business case for a service that is a profound need for people. Unfortunately, in these times one has to count every euro and cent. I am hopeful the business case, developed with the HSE in conjunction with Beaumont Hospital, the many stakeholders such as the Happy New Ear group and the UK experts in this field, will provide us with a plan for ensuring delivery of this service.

It is difficult when one hears terms such as “resource constraints” and “unhealthy budgetary and fiscal conditions”. However, I urge the Minister, Deputy Reilly, and Minister of State, Deputy Kathleen Lynch, to prioritise this matter. For many years it was not seen as a priority, as evidenced by Dr Laura Viani. There is now a commitment to help the parents and the wonderful children who deserve our support, however. I hope the efforts of the Ministers, the Happy New Ear group and the marvellous parents will bear fruition to allow our services in this area catch up with other countries and give young people an opportunity to have this operation at an early and sensitive stage for their benefit.

Ann Phelan (Carlow-Kilkenny, Labour)
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Earlier, I was struck by the openness and frankness of the Minister of State, Deputy Kathleen Lynch, in dealing with this issue. She referred to constraints on her budgetary resources but, today, she stated bilateral cochlear implantation will be a priority for her. If I know Deputy Kathleen Lynch, once she says something, she does it. She has not promised anything above and beyond, marching people up a hill only to march them down again. I take her at her word that she has made this matter a priority.

We understand how difficult and frustrating this issue is for the parents of children requiring bilateral cochlear implantation. When one knows that a second implantation would significantly improve one’s child’s life, it must be very tormenting not to be able to get it and ensure one’s child has the best start in life. Deputy Halligan stated if one was doing an operation on a blind person, then one would not replace one eye but both. I happen to know quite a number of people who are blind and who, if they had any chance of having their sight restored, would be very grateful to have it restored even in one eye. I am not making an excuse for the issues concerning bilateral cochlear implantation.

Luke Flanagan (Roscommon-South Leitrim, Independent)
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It is just an excuse. What else is it?

Ann Phelan (Carlow-Kilkenny, Labour)
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It is not. Just because you sit on that side of the House does not mean you have the monopoly on concern. I am sick of coming in here for these debates and just because you sit there, you think you know everything and have the monopoly on all of this. You do not.

Peter Mathews (Dublin South, Independent)
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Through the Chair, Deputy.

Ann Phelan (Carlow-Kilkenny, Labour)
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You are holier-than-thou. I know these people as well and I work hard for them too. I take great exception to that comment.

Luke Flanagan (Roscommon-South Leitrim, Independent)
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Nonsense.

Ann Phelan (Carlow-Kilkenny, Labour)
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A cochlear implant is a sophisticated device which helps people with profound hearing disabilities to have access to sound.

Luke Flanagan (Roscommon-South Leitrim, Independent)
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I have to say I am delighted to hear that.

Peter Mathews (Dublin South, Independent)
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Through the Chair, Deputies.

Ann Phelan (Carlow-Kilkenny, Labour)
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Yes, but I know I have to act responsibly within the constraints of the budget.

With the introduction of a bilateral programme, those children that have already received one implant would need to be assessed for candidacy and provided with relevant information about advantages and disadvantages of a second implant. In Britain, the authorities recommend simultaneous bilateral cochlear implants as the best option for children. For those with one implant already, however, it is recommended they should have an additional implant only if it is considered to be of sufficient benefit to the recipient. It is advised a full and frank discussion should take place between the recipient and their parents or carers. This would initiate a programme of a pre-assessment, operation and fitting, and post-operative care. It also would outline how secondary implants could be provided to the children who have had one implant already and have already been assessed.

The proposal the HSE is following outlines the estimated requirements for the introduction of a simultaneous bilateral cochlear implantation programme and sets out how the sequential implantation may be managed. This proposal will involve the recruitment of extra staff, the purchasing of equipment and further building works and will be dependent on additional funding being made available.

The Minister of State, Deputy Kathleen Lynch, stated earlier she is making this her priority. The Deputies on this side of the House will make it their priority too.

Eamonn Maloney (Dublin South West, Labour)
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I extend my congratulations to the campaign of the Happy New Ear group in informing people like myself on this issue, which is of great importance to them and to those of us who are able to advance a service that will resolve the issue. I recall that one parent in the group told me that having the two implants had profoundly transformed her daughter’s life for the better. It is indisputable that this service has to be introduced. There has been delay upon delay in introducing the service, going back to the time when we were told the country was rich. It is a source of frustration for some of the parents whose children did not get the service at that time, as well as adults. However, the HSE has put down a blueprint for the provision of a proper and full bilateral cochlear implantation service.

These people and their families deserve nothing less than that.

I do not want to go over issues to which speakers on both sides of the House have referred. The argument is conclusive. I referred to the review the HSE published in 2011. The Department allocated €3.7 million for the service in 2011 and €2 million this year. Like others, I have listened to the Minister, Deputy Reilly, and the Minister of State, Deputy Kathleen Lynch, who was straight and honest about it. She did not try to delude people or tell them lies that something will happen overnight when it will not. These people have heard all this stuff before from politicians who are long gone from this House. This is an open and shut case. This changes people's lives, whether adults or children. It is for all of us, but we on the Government side will take seriously our responsibility to advance this and put in place a service that meets these families' needs. It must be done and I will support the advancement of such a service.

Gerald Nash (Louth, Labour)
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This time last year I had no idea what bilateral cochlear implants were. Now, 12 months on, I have no excuse. I know exactly what they are, what is involved in getting them and what they mean to the many children who, sadly, have heretofore been denied the prospect of obtaining the ability to hear like most of the rest of us. This challenge was first brought to my attention by the local media in Drogheda, after which I contacted the Connor family, who will not mind being mentioned. Earlier in the debate Deputy Adams referenced a number of people he had been in contact with. The Connor family have a son, Alex, who, like hundreds of other children across the country, needs the kinds of intervention that are in this motion and the amendment.

As the House will be aware, the Minister of State, Deputy Kathleen Lynch, hosted a very constructive meeting with the Happy New Ear group officials and experts in audiology services in her office last May. It was clear to me from that meeting that Deputy Lynch and her officials have a very real awareness and understanding of the requirements of the children involved. We have reached a stage at which that awareness and understanding must be translated into real and concrete action. All international medical evidence points to bilateral cochlear implants being best practice in terms of patient outcome and, ultimately, long-term costs and efficiency in the health service. That important point should not be lost on the many people who see the cost of everything and the value of nothing.

For the patient, bilateral implants offer a vastly improved experience in hearing quality, not just range and volume but also the ability to discern and filter different sounds. We all take spatial awareness for granted when we cross a road or hear someone call our name. That is very severely limited if only one implant is used. The effect was described to me as being like the loss of perceived depth when one loses an eye. On the medical front, the active nerve endings needed for cochlear implants will die if not stimulated during cortical development, leaving possible future technology futile. It is not always possible to select the better ear for the implant. We should never depend on guesswork, no matter how informed it might be.

One of the most compelling arguments for bilateral implants is the possibility of device failure. The impact of that was described to us in earlier presentations by the excellent Happy New Ear group. This technology produces seemingly miraculous results, but technology sometimes fails. We all know that. When members of the campaign group visited the Dáil some months ago one of the parents told us a very compelling and emotive story. Her child had been happily playing with the type of noisy toy beloved of all children and seemingly designed to drive parents mad. The child said the toy was broken, holding it up in the expectation all children have that mammies and daddies can fix everything. The toy was not broken. It continued to whistle, buzz and shriek as these toys do. The implant was broken and the small child, with no understanding or explanation, had been plunged back into a world of silence.

There are some things mammies and daddies cannot fix. There are many things only we in this House, and in this Administration, can fix. The system as it pertains to these children is not working and we have the power to fix it. It is so very important for the children concerned, their parents and the Happy New Ear group that the HSE national services plan to be developed over the next few weeks reflects the excellent, very strong and robust case made by the experts and families in recent months. I congratulate the families on the level of engagement they have had with public representatives across the political spectrum, the impact they have had on HSE and Department of Health officials and the Ministers, Deputies Reilly and Kathleen Lynch, who will do their utmost to ensure the things we in this House want to see happening are made happen in the HSE's national service plan.

Seán Crowe (Dublin South West, Sinn Fein)
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The key issue is that this is a race against time. We should have that focus when we make decisions. It is the difference between a child retaining his or her hearing and losing it. We must act on that. It is unacceptable for families to leave this debate unsure what will happen. I listened to the speech of the Minister of State, Deputy Kathleen Lynch, and there are some positive things in it for the families. She talked about a model of care for paediatrics nationally. She also talked about the objective of the right child, the right place and the right time. Is anybody going to tell the families in the Gallery that their child is not the right child, that they do not live in the right place, that this country is not the right place for them or that it is not the right time? The time is now. We need to make this decision.

Speakers have said this technology is life-changing for these children, so what is the argument against it? The argument is that it will cost €18,000 to €20,000. The money for this is in the Irish economy. Does it mean we have to tax somebody else who has the money? Why can we not do that? It is about choices. Society disables, and that is what is happening here. Some people said this was being turned into a political issue. Politics and politicians have failed these 200 families. There is a responsibility on all of us in the House to move this forward. The point of today's motion is to try to move it across the line. It is a political issue and must be tackled by politicians in here.

We have heard the argument that the provision of only one implant limits a child's ability to distinguish where noises are coming from and to hear in busy or noisy places such as shopping centres and classrooms. That is key.

Hearing is a vital sense for all, but we continue to work against best international practice and limit many children's ability to reach their full potential and communicate with others. This is what the argument is about. This is the right thing to do and would be good for the child and society. It would create conditions that would allow children to reach their full potential. No matter what people say, there is no argument against this. The old argument is made that it cannot be done at this time, that we must wait another while or that the Government will look at the issue or that a move might be made on it next year. That is not good enough for these families. It is unfair to put people through this situation. I believe this is an issue that can be sorted out by politicians. If Members are as concerned as they say they are, we can move forward on it.

Many years ago, during my first term as a Member of the House, I had responsibility as spokesperson on a number of portfolios. I recall being invited to attend an annual general meeting of the Irish Deaf Society in the Aisling hotel in Dublin. I attended that meeting and was told I was the first Deputy who had ever turned up to an annual general meeting of the society. I do not know if that is true, but it is what I was told. I was shocked to hear that no politician had ever officially turned up to its annual general meeting. The people in the Irish Deaf Society have found their voice now and the families here representing their children have gathered together on this campaign. It is not acceptable for people to come in and vote against this motion. This is the right thing to do. People need to look into their hearts and decide what is the right thing to do.

Speakers have talked about their motivations. The Minister of State, Deputy Kathleen Lynch, spoke about what motivated her involvement in politics. This is an issue that should motivate all of us. If we cannot make a decision on this today, we must work collectively and come up a solution that will give some ray of hope to these families and their children.

Martin Ferris (Kerry North-West Limerick, Sinn Fein)
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I would like to comment on the response of the Minister of State, Deputy Kathleen Lynch, to the opening remarks from Sinn Féin. Her departure from her prepared speech was encouraging and showed a certain amount of emotion and feeling. This was far different from her prepared speech, which was probably written by a faceless civil servant, lacked emotion and contained statistics and so forth. I welcome the fact that she departed from it and that she has indicated a commitment down the road on this issue, although we will argue that is not good enough.

As others have pointed out in this debate, the current practice in this State of implanting just one implant, for those fortunate to be approved for treatment, is out of step with what is regarded as best practice in other countries. The medical evidence is that this does not fully address the hearing problems of the children concerned. It has been found that the provision of only one implant limits a child's ability to distinguish where noises come from. It also fails to address fully their lack of ability to distinguish other voices in busy or noisy places like shopping centres and classrooms. This is similar to the experience of many adults who have hearing difficulties and is obviously not a solution to the problem, which clearly requires that the children concerned are given two implants rather than one.

For those who receive just one implant, the sort of problems I have described regarding their ability to distinguish voices adds considerably to the difficulties that school-going children experience in a classroom setting. If children cannot hear what is going on in a classroom and are unable to hear what a teacher is saying, it will severely impact on their ability to keep up with what is being taught and may lead to educational disadvantage that will persist throughout their schooling. It will also potentially hamper their communication with other pupils and, therefore, have a detrimental impact on their social as well as educational development if they are unable to fully participate in social interaction with their fellow pupils. Of course, this would also have an impact on any children with this issue who may wish to participate in sport, as the failure to fully address the problem through the provision of bilateral implants will affect their ability to hear what is going on within a sporting context.

The testimony of the families of the children concerned makes their plight apparent. On their Facebook page, parents describe their joy and indeed gratitude over their child having received one implant. Some of them describe it as their children's first step into the world of hearing and recognise the huge difference an implant makes to the child's life. However, they also describe their frustration at the problems encountered by the same children because they only have one implant, who therefore still exhibit some confusion in their day to day activities. Their condition, while undoubtedly improved, is not unlike the situation and frustrations encountered by adults who are starting to experience hearing difficulties.

In September 1961, my mother, who was in her mid 30s then, woke up one morning totally deaf. This was during the harvest season and she worked that day and the next without any treatment. Eventually, she ended up in Limerick Regional Hospital and after treatment she regained partial hearing with the help of a hearing aid. What I remember most after that time is the frustration experienced by my mother in trying to pick up what was being said by other people because she had so little hearing. I also remember the frustration experienced by myself, my brother and our family in trying to communicate with her and, sometimes, the lack of tolerance towards my mother in that regard. That was a long time ago, but ironically I wear two hearing aids today. I hope people show me more tolerance than was forthcoming at that time.

A recurring analogy employed by the parents is that addressing the problem through one implant is like addressing blindness by providing one eye. It may be argued by some that the number of children who are affected by this issue is small and, therefore, it is not something that ought to be prioritised. Currently within the State there are in the region of 200 children in this situation. They would benefit greatly from the introduction of a bilateral cochlear implant programme. Because the number of children concerned is small, the cost of ensuring that they all receive bilateral cochlear implants would be relatively small. It would represent only a drop in the ocean in terms of the overall health budget. However, it would be money well spent in addressing the plight of the children concerned and the difficulties faced by those children and their families.

There is an onus on all elected representatives to do the right thing and what we think is best. If we can make life more tolerable for the parents, families and friends of unfortunate children born into this situation by making money available from a budget, this will make a huge difference to their lives. These implants can ensure they develop social interaction skills, give them the opportunity to have a full education and enable them to have a life of communication by sound with their families, friends and everybody else. If we only do this and nothing else, we will be doing a good job as elected representatives. The onus of responsibility lies with all of us, but in particular with the Government. While I accept the sincerity of the Minister of State regarding the plight of these children, there is an onus of responsibility on her and the Government to ensure we address the issue collectively.

I urge everybody to support the principle and the merits of this motion because we on this side of the House are trying to make life better for unfortunate children who have not had a chance. We can give them that chance.

Michael Colreavy (Sligo-North Leitrim, Sinn Fein)
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While I am happy to be here and welcome the families of deaf children to the House today, I do not know why we are still here dealing with this, because it is an issue that should have been sorted out years ago. I confess, to my shame, that it was only when I attended a briefing hosted by Deputy Adams here in July that I got an insight into cochlear implantation and the case being made for children to be given bilateral implants. I did not realise that children were refused a double implant and were only given one.

The briefing was given by Dr. Laura Viani, who is the surgeon with the cochlear implant programme in Beaumont Hospital. She is the person who performs the operation that gives hearing to the children concerned. One could see the esteem in which she is held, and the gratitude expressed for the treatment received by the children was apparent from the fact that many of the parents of children in need of bilateral cochlear implants also attended the briefing. These are the parents pressing the Government to introduce a programme to ensure their children receive bilateral implants. This is considered to be a Sinn Féin Private Members' motion, but it is not; it is that of the parents and families. I trust the Minister will listen to the debate and, more importantly, pay heed to the genuine case being made in support of bilateral cochlear implants for the 200 children concerned. It is not a number that would sway a marginal constituency. To date, the Minister has indicated that he supports the creation of such a programme at Beaumont Hospital, as has the HSE, but he continues to point to resource constraints. Yesterday, when I spoke briefly on the budget, I stated that this was unacceptable when it comes to the health needs of the most vulnerable in society.

One of the most striking points made by Dr. Viani was about the need to perform the procedure when the children are young enough to take advantage of it. She pointed out that if it was not performed before the child had reached the age of eight the operation would not work. After this age, children who have lived all their lives in silence will never learn how to speak. We do not have the luxury of time. One can state with regard to most issues that we will examine them next year, and that is fine, but we do not have the luxury of time on this. If it is deferred for a year children will not be able to hear or speak.

Dr. Viani also stressed the need for two implants rather than one, and compared the provision of single implants to providing glasses with only one lens. With regard to funding, she claimed that because of the high costs associated with a lifetime of support to a person who cannot hear, a cost-benefit analysis would fall in favour of providing double implants. The medical evidence in support of bilateral cochlear implants is clear. An expert in the area, Dr. Litovsky, wrote a paper which provided evidence not only of benefits in the form of enhanced hearing, particularly in noisy environments, but also social and personal developmental benefits to the individuals who have had this treatment. Dr. Viani also referred to the greatly enhanced language learning capacity of people who have been provided with bilateral rather than individual implants. She even claims that understanding what is being said and memory retention are enhanced because less effort must go into actually taking in what is being said, as opposed to comprehending and processing what is being said.

On a human level, the most significant evidence is the fact the vast majority of bilateral implant users report substantial improvements in the quality of their everyday life. They may sound like small things to us, but they include being able to hold a proper conversation; taking part in work; being able to hear what is happening at meetings; being able to distinguish separate conversations in noisy locations, such as the Dáil often is; and being better and more safely able to drive. There is a compelling case in favour of providing the children in need of this procedure with the means to ensure they have a proper quality of life, and money ought not be an issue.

Yesterday when speaking on the budget I stated that I recognised that most people in political parties were decent and honourable and had come into politics for all the right reasons - to help those whom we represent. There really is only one honourable thing the Government can do with this motion. There is only one decent thing Government backbenchers can do with the motion. I do not care who claims the credit for it. Give the credit to the parents of the children who need the procedure and do not give the credit to Sinn Féin, but do the right thing. We can immeasurably improve the quality of life of deaf children and their families if we immediately authorise the fitting of bilateral implants instead of the current mean-spirited and uncaring practice of fitting one. I ask Deputies to imagine it were their child or grandchild. Would they consider it decent that he or she should go from hearing to deafness because of the failure of a single implant? What a prospect. None of us would want it for our children or grandchildren. Would we consider it decent that our children or grandchildren could not listen to and enjoy beautiful music? We would not. I ask all Deputies to do the right thing. If we cannot and will not do the right thing now, we have lost more than economic sovereignty; we have lost our soul, our compassion and our decency.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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I welcome the parents from the Happy New Ear campaign in the Visitors' Gallery, the medics at Beaumont Hospital and, particularly, the irrepressible and legendary Dr. Viani, who not only does her medical work but has been so much a part of the campaign.

This is not a party political issue and it should not be a political issue at all. The fact that Sinn Féin has introduced the motion is a detail. What people need to focus on is the content of the motion. It makes three statements which are uncontested. It recognises that bilateral cochlear implants are the best approach for a deaf child. It is the necessary intervention to give hearing to children who are deaf. It also states, which has not been contested in the Dáil, that because of the development of the auditory nerve there is a window of opportunity to make the intervention for small children and this window closes at approximately the age of eight. It also states that the costs envisaged in giving second cochlear implants to approximately 200 children are modest. In recent days we have spoken about hundreds of millions and billions of euros. Decisions on sums of money of this magnitude have been debated in the Dáil and decisions have been proposed. In the case of these children, we are looking at a potential spend of approximately €12 million or perhaps €13 million, and even the Minister has conceded that all of these moneys do not have to be found up-front.

We find ourselves in a very bizarre situation in which the Government and the Opposition - Independents, Sinn Féin, Fianna Fáil, Fine Gael and the Labour Party - all recognise that the children need bilateral implants, that a clock is ticking for them, and that the costs involved are modest. Anybody with an ounce of common sense would look in and wonder why a debate is even under way on the matter. Why does it take a Dáil debate for an uncontested matter to be sorted out?

I am disturbed by the term "business case", which has featured in the discussions today. I appreciate absolutely that, in the spending of any taxpayers' money, there has to be a plan and accountability, and there cannot be waste. However, I am greatly troubled that we have to make a business case for the health of our children. It bothers me, and it would really anger me, if I were the mother of a deaf child, to hear that a business case had to be presented, picked over and approved to allow for my child what is a fundamental health intervention and a fundamental right, namely, the right to hear.

I am not a medical expert but I am a mother. I remember, when my second child was born, that at one stage there was some query about the quality of his hearing. Subsequently everything was fine for my son, but I remember the kind of panic we had at the time in bringing our new child home, and the worry that there might be some difficulty with the child's hearing. It is worthwhile for all of us to put ourselves in the shoes of parents who bring their new babies home in the knowledge or to discover that the child has profound hearing issues and deafness. Today's debate is not about politics; it is about decency and humanity. It is not about looking for gratitude from children or their parents; it is about doing what we are elected to do. To my way of thinking, if we cannot pass a motion on which all of us in this Dáil agree, and which will provide such a transformation in the lives of hundreds of children, I wonder why we are here.

The Minister, Deputy Reilly, has a very big budget to manage. He has to make big savings and in some cases big cuts, he tells us, but this is a modest sum of money. I do not believe for a second that the Minister wants the 200 children who could avail of this second implant to go without that. I have no doubt that Members in government have their frustrations from time to time, and I have no doubt that some of us on the other side of the House are very often the source of those frustrations. However, what they on the other side have that we do not have is the ability to finally take the decision and to give the instruction to the system to do the right thing. I envy them that. I can tell them, if it were my call or the call of any of my colleagues, financial constraints or not, budgetary concerns or not - dare I say it, health overspend or not - the €12 million needed for capital expenditure, resourcing and staffing to make sure these children get their second implants would be found, whether we have to beg or borrow. I recommend that to the Minister. I say to him and his colleague, Deputy Kathleen Lynch, that whatever other priorities or concerns emerge, they must not let the opportunity of the HSE service plan go without an allocation to put things right, in as much as we can put them right for these hundreds of children.

I know many Members have had correspondence from parents. I received correspondence yesterday from a mother, who wrote:

My daughter is just three. She has her implant a year and it has been amazing to go through all the firsts - hearing her say "Mama", "Dada" and learn to understand what we say to her. ... A cochlear implant truly is a miracle of modern technology. We are so grateful for it. A second implant would give our daughter better quality sound, localisation, better hearing, so she can appreciate music, and focus on sound in noisy situations and block out the background noise.

James Reilly (Dublin North, Fine Gael)
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I welcome the opportunity to speak about the very valuable work that is under way in audiology services and the national cochlear implant programme. I am aware that since the cochlear implant programme commenced at Beaumont Hospital, more than 700 patients have received cochlear implants. I also know that the programme does much more than provide surgical services. It also provides an assessment service to potential candidates and a rehabilitative service to those who are actually implanted.

While the programme has provided single implants to date, it is now considered best practice worldwide that children should have bilateral cochlear implants, and I do not believe there is any disagreement about that. I was very pleased to meet with the group Happy New Ear in July of this year and again today, and to hear from them at first hand about this issue. I know that Happy New Ear also met with the national clinical care programme in audiology on two occasions this year, as well as with my colleague the, Minister of State, Deputy Kathleen Lynch, who spoke earlier.

As the Minister of State has already outlined, the HSE, with Beaumont Hospital, has developed a proposal to introduce a bilateral cochlear implant programme in Ireland. I welcome the fact that, in developing this proposal, the HSE had input from Happy New Ear and other stakeholders. It is also very important to note that the proposal drew on the input of two UK experts who were engaged to advise on how to make progress on this complex development. A bilateral cochlear implant programme will involve the assessment, fitting and post-operative follow-up of simultaneous cochlear implants. The proposal also outlines a number of options for a sequential programme - that is, the provision of second implants to children who have already received one implant and who are assessed as being suitable for a second.

The introduction of a bilateral cochlear implant programme - both simultaneous and sequential - will obviously be dependent on the availability of additional funding. As people will be aware, yesterday's budget saw the announcement of the Health Estimates. Once again, 2014 will be a very challenging year for the health service. I am pleased to have been able to prioritise children's health care with the commencement of free GP care for children aged five years and younger. I believe this measure will ensure better medical outcomes for children and more treatment taking place in the community rather than in hospitals. I also want to note that my colleague, the Minister for Public Expenditure and Reform, Deputy Howlin, reconfirmed the Government's commitment to make up to €200 million available from the sale of the national lottery licence for the new children's hospital. This capital project is an absolute priority for me and for the Government. The new building is one side of the equation; the services for children, and the people who deliver them, make up the other. That is why I have established a children's hospital group, the board of which includes members from both within and outside paediatric health care, which brings new and different perspectives and insights from outside the world of health care to join with the expertise and experience of those from within that world. I very much welcome the fact that the three paediatric hospitals themselves are committed to coming together and that work is under way on integrating services across the three hospitals.

As I conclude, I must reiterate there is no question but that the 2014 budget for the health sector represents the greatest challenge the health sector has ever faced. Full details will be worked out, worked through and set out in the HSE's national service plan, which must be submitted to me in early November.

Knowing the challenges ahead, it is important to be clear that the resources needed for the introduction of a bilateral cochlear implant programme, and indeed any service development, must be considered in the context of the service plan and in the context of my over-riding priorities of quality and, in particular, patient safety.

In conclusion, much as the Deputies opposite might wish to stand in my shoes today, the choices we have had to make in this budget have not been easy. Some of them have been very hard and some of them have resulted in things such as the prescription charge, which is not the direction in which I believe our health service should be going. However, our country is in the hands of others as regards our finances, so we are anxious to exit this bailout and get our financial sovereignty back. I must make choices about this very sensitive issue, which is a priority for me, and other matters such as screening for diabetic retinopathy, which can cause irreversible blindness if not detected early. There are no easy choices, but this issue will be one of my top priorities. I look forward to the opportunity of having that priority expressed in the national service plan.

Brian Stanley (Laois-Offaly, Sinn Fein)
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I listened carefully to the Minister's contribution on this issue. The fact is that children in the State who receive cochlear implants only receive one, and will still only receive one after the Minister's comments today, rather than the two which the Minister admitted is best practice in other countries.

The provision of cochlear implants for children is an issue of fundamental rights. Children not only have the right to be heard but also the right to hear. It is a race against time as the auditory nerves to which the implants are connected become more redundant every day and will eventually die if they are not being used. According to Dr. Viani, the surgeon with the cochlear implant programme in Beaumont Hospital, unless these implants are connected in the early years, by the age of seven or eight years the operation will be ineffective. After that, children born and raised in silence will never speak, and that is a huge difficulty that has an adverse impact on the rest of their lives.

The cost of a single implant is between €18,000 and €20,000. The provision of only one implant limits a child's ability to distinguish where noises are coming from and limits their ability to hear in busy or noisy places such as shopping centres, classrooms and urban environments.

We wish to ensure that all children fully participate in our society. This motion is about ensuring that these 200 children can do that. Children who are deaf require greater educational support and special care packages and often suffer serious psychiatric problems and depression later. They also have difficulty getting work. With cochlear implants they can make a positive contribution to society and find it easier to get employment and fully participate in society. There is not only a moral argument for this, but also an economic argument. Obviously, it should be the least important one, but there is an economic argument for ensuring these children have two implants. Having only one implant can seriously limit their ability to reach their full potential and to communicate with others. For the sake of €18,000 per child we could have 200 more fully engaged, active and participating citizens.

I know money must be found somewhere. If we reduced the salaries of those with the highest incomes at the top of the public sector and the health services, we might find money to provide these implants. There are 200 children who would benefit from this. Some of their parents have formed a campaign group, some of whose members are in the Visitors' Gallery, to ensure this programme is established as a matter of urgency. I applaud and commend them on their Happy New Ear campaign and for continuing to raise and keep this issue on the political agenda on behalf of their children. Somebody must speak up for their children.

The Government has the solution. The problem is that as the child grows the nerves to which the implant should be connected die if they are not being used. The hope of a further implant is lost. However, this is an issue that can be resolved. The solution exists and is best practice in other states in the developed world. The amount of money involved is relatively small, even in these straitened times. If the political will exists, we should be able to do this.

I will leave the last word to one of the parents.

Please meet our little boy Alex. He is three years old and profoundly deaf. On the third of October 2012 he was blessed to have a cochlear implant in Beaumont hospital under the great care of Dr. Laura Viani and Dr. Walsh. Since that day we are on a long journey to help him listen and distinguish sounds. His whole little life he has struggled with life due to not hearing. Now he has begun to hear but only one cochlear implant is just not enough. He finds it hard to locate where sounds are coming from and every day we see his confusion when he hears something and cannot work out where it is. There is a solution to this. Bilateral implantation is proven to minimise these problems and all over Europe and the USA it is standard practice to implant both ears, but not in Ireland. Funding has not been made available. It seems ridiculous because if someone was blind and they could operate to fix it, would they only do one eye?

I appeal to the Minister to do the right thing. Allow these children to develop and grow to become full members of society.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Gabhaim buíochas le gach Teachta a ghlac páirt sa díospóireacht tábhachtach seo. Gabhaim buíochas ach go háirithe leis na tuismitheoirí atá linn inniú agus molaim iad as an feachtas atá ar siúl acu agus tá súil agam go neireoidh leis go luath.

I thank all the Deputies who have taken part in this debate. I believe this is an issue on which there is agreement. The outstanding matter is whether there is the political will to do it now. We must all come together on that and ensure the decision is made to do it now. I especially acknowledge and thank the Happy New Ear campaign and the parents of children requiring bilateral cochlear implants who have joined us in the Visitors' Gallery for this debate. I wish they had not been obliged to be here again today and that we did not have to address again this very important issue.

We hope this debate and sincere appeal to the Government will mark a very significant step towards the early and full achievement of these families' goal, which is the gift of hearing for their children and for countless other children who will require bilateral cochlear implants in Ireland in the future. Many complex and complicated issues come before the Dáil each week, none more so than the budget that was announced on Tuesday. However, this is a very straightforward and simple issue. It is not complicated or complex. There are no conflicting arguments about the benefits of bilateral cochlear implants, and the Minister has acknowledged that. Children need this operation and they need it now. This is the emphasis of my closing appeal to the Minister. Unquestionably, this decision must be taken now.

I regret that the Minister for Health did not accept the motion but chose to amend it. I will deal now with that amendment. The first part restates the current position regarding audiology and quite rightly commends the work being done in Beaumont Hospital on cochlear implants for both children and adults. The last part of the Minister’s amendment is apparently irrelevant as it talks about the new national children’s hospital and the national clinical programme in paediatrics and neonatology. I say "apparently irrelevant" on purpose, because I have a serious concern at the presence of those points in the amendment, points which the Minister repeated in his short contribution a few moments ago.

I hope it is not being suggested by him in a subtextual way that the provision of bilateral cochlear implants for children might have to await the completion of the new national children's hospital, as that would be totally unacceptable. The substance of his amendment recognises that the report of the national audiology review group recommended bilateral implants. It notes that initial estimates of the additional resources required are being examined with regard to the model of care required and the costings. That, unfortunately, is as far as the Minister goes in his amendment. It is most regrettable that it does not fully recognise the vital importance of bilateral cochlear implants. He should at least have recognised the worry, concern and anguish of parents who see that the clock is ticking and that if these operations are not made available as soon as possible, it may be too late for their children to benefit from them.

I want to summarise the case we have made and put it to the Minister and the Government. Thanks to the Happy New Ear campaign, it is now widely known that children in the State who receive cochlear implants receive one, rather than two, implants. The provision of two implants is accepted as best practice internationally. The case is best made by the parents of these children and I want to read the testimony from a parent. The child concerned is now slightly older than she was when the parent wrote to me:

Our beautiful daughter Taylor Beth is now two and half years old. She has the biggest green eyes you have ever seen and can tell you in a blink exactly what she wants! It's just as well she can do this as Taylor can't speak yet. She was born profoundly deaf and due to a late diagnosis, 19 months had passed without her hearing a sound. She began using sign language shortly after her diagnosis and to date has just short of 200 signs. Even though she hasn't found her voice yet, this is one little lady who can still put you in your place!

Thankfully Taylor was given the gift of hearing in November 2012 and since then has come on leaps and bounds. In these two short months she has started babbling like any hearing baby would start off and has finally turned to her name!! It truly is a miracle. There is a downside however...

Our daughter is exhausted in the evenings as her little brain has had to work so hard to process all the sound coming in through just one ear. With the aid of a second implant this wouldn't be the case. Why should our children miss out on their childhood because they are too exhausted to go and play after school? Or not know in which direction that phone is ringing - all because there isn't enough funding. These are simple little things to us but to her and the other children this could be life changing.

Please share our story and help us in the fight to gain bilateral implants for our little ones. We were all given two ears to hear - give these children what is rightfully theirs.

At a meeting of the Oireachtas Joint Committee on Health and Children this morning I asked the Minister to provide for bilateral cochlear implants in the 2014 HSE national service plan. He said he had made it one of his priorities, just as he said so again here, but he went on to cite scarce resources. The Minister of State, Deputy Kathleen Lynch, did the same during this debate. The Minister makes the same delaying excuses, but I must call it as I see it. His are delaying excuses and unacceptable, as he knows.

In a letter to Deputy Gerry Adams in July 2013 the Minister sounded a much more positive note and stated the proposal for the development of a bilateral cochlear implant programme at Beaumont Hospital would be submitted as part of the HSE Estimates process. I regret to note that the tone from him and the Minister of State today was less positive than in his letter in July. Trying to read between the lines of the speeches made today, I sincerely hope it is not the case that this plan was submitted as part of the pre-budget Estimates process but rejected at that stage. Is this a battle the Minister fought but which has since been put back? Even if that is the case, he can succeed if he has the political will. He will have the applause and acclaim of the House if he delivers on this simple and straightforward issue. We will not hesitate to properly commend him in full. Governments have to be called to account. Political pressure has to be applied to ensure they do the right thing. I take with a pinch of salt the statement of the Minister of State that the motion would have been better timed after the HSE service plan is published. On the contrary, that would be too late.

The Minister should see the motion and these contributions as a collective endorsement of his efforts not to seek to deliver but to deliver. We will not rest on anything other than success in delivering the programme in the national service plan for 2014 in order that the children children have their rights and their parents can look forward to their children having the opportunity to fulfil their full potential as young people facing into later life. The Minister must go bolder from this Chamber, knowing that we are all behind him in this matter.

Seán Barrett (Dún Laoghaire, Ceann Comhairle)
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Before coming to Topical Issue Matters I ask the Minister of State at the Department of the Taoiseach to move a motion.