Micheál Martin (Cork South Central, Fianna Fail)
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One of the more optimistic sentences in the programme for Government reads, "We are committed to sustaining the progress made to date on waiting lists, and are committed to" further investment, etc. As the Taoiseach will be aware, the reality is that the waiting lists have gone in the opposite direction and are at an all-time record high. Quite appalling figures in a range of medical disciplines in almost every hospital throughout the country are going through the roof. There is a real crisis here. The programme for Government commits to "agree[ing] annual performance targets with each Hospital Group/Trust and CHO (Community Healthcare Organisation) on waiting times, linking to activity based funding.", and states, "We will establish a Performance Management Unit providing assistance to hospitals and service providers in reaching their targets." Given the abysmal results in terms of the worsening of the waiting times and the waiting lists, can the Taoiseach indicate what progress has been made on those programme for Government commitments?

Enda Kenny (Mayo, Fine Gael)
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It is worth noting that there are 3.2 million outpatient attendances at hospitals every year, that 100,000 patients have elective inpatient procedures and that 800,000 have planned day-care procedures. The number of patients who are waiting to be seen or treated, while unacceptably high, needs to be considered in the context of the total number of patients who are seen and treated.

The programme for Government commits to €50 million in 2017 for waiting list initiatives, with at least €15 million of this money allocated specifically to the National Treatment Purchase Fund, NTPF, which the Deputy has raised on a number of occasions. In direct response to those increases, the HSE has provided the Minister for Health with an action plan - to be implemented in the second half of this year - that is aimed at reducing the number of patients on waiting lists. Key actions of that plan include: clinical validation of patients waiting for inpatient or day-case procedures for over 15 months; focusing specifically on providing procedures for the 5% of patients on inpatient and day-case procedure waiting lists for over 18 months; and driving the process of improvement at hospital group and individual hospital level with the support of the special development unit.

Data has shown improvements in the overall endoscopy situation and in the waiting lists relating to and waiting times for endoscopy of 15 months. The Minister recently opened endoscopy units at the Beacon Hospital and Roscommon County Hospital. The Minister is conscious of the major role of the endoscopy procedure, both in advancing the treatment of gastrointestinal diseases and as a diagnostic and investigative tool significantly improving outcomes for patients. I will advise Deputy Martin in respect of the performance indicator system to which he refers.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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More than 1,000 people in direct provision centres across this State will receive their Christmas bonuses this week - I say that with tongue in cheek to some degree. It will amount to €16.23 for adults and €13.26 for children.

3 o’clock

Given that adults only receive €19.10 per week and children receive €15.60 per week, it is clear that all of these families will have what one could only call a very poor Christmas. The Government is responsible for a system of detention that guarantees poverty for asylum seekers. The McMahon report recommended increases in payments for children and the opportunity to work for adults while their cases are being assessed. When will these recommendations be implemented? Of the 4,301 people in direct provision centres at present, 614 are in direct provision for more than five years. It is a scandalous situation and absolutely unacceptable. In the most recent review of progress in implementing the McMahon report, the Government admits that 82 of the 173 recommendations have only been partially implemented or have seen no progress. When does the Taoiseach expect the outstanding recommendations to be implemented and can he update the House on the status of the immigration and residency reform Bill?

Finally, the key recommendation of the working group was the introduction of a single application procedure in the protection process. The International Protection Act 2015 provides for such a procedure. Can the Taoiseach indicate when he expects the commencement of the International Protection Act?

Enda Kenny (Mayo, Fine Gael)
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I will ask the Minister of State at the Department of Justice and Equality, Deputy Stanton, who is dealing with these issues and who has visited most of the direct provision centres, to respond to the Deputy.

David Stanton (Cork East, Fine Gael)
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I have visited most of the centres by now and much progress has been made with respect to the McMahon report. We are putting in place a provision whereby people can cook meals for their families and we are putting families into family-specific units. I have visited those and spoken to the people and they report that they are quite happy there. Many people move into and out of provision all the time so the number is approximately 4,000, as the Deputy said. We hope to have the legislation enacted at the end of this year, if not sooner. If not, it will be very early next year. Much work has been done on commencing the Act in law and having it working soon.

Catherine Connolly (Galway West, Independent)
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Mar Chathaoirleach ar Choiste na Gaeilge, na Gaeltachta agus na nOileán, tá soiléiriú ag teastáil uaim ar Acht nua na dteangacha oifigiúla. Cá bhfuil sé? Go háirithe, maidir leis an gcóras, cén chaoi is féidir leis an gcoiste an tAcht nua sin a phlé? Sin atá ag teastáil uaim. Tá a fhios agam go bhfuil an tAcht beartaithe ag an Rialtas ach tá muidne ar an gcoiste ag iarraidh go dtiocfadh sé os ár gcomhair go práinneach, ionas go mbeimid in ann obair as lámh a chéile agus Acht nua a chur chun cinn. An bhfuil gá le cinneadh sa Dáil chun an tAcht nua sin a chur os ár gcomhair nó an féidir leis an Taoiseach, an tAire sinsearach nó an tAire sóisearach an cinneadh sin a dhéanamh?

Enda Kenny (Mayo, Fine Gael)
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Tabharfaidh an tAire sóisearach freagra don Teachta. Tá obair á dhéanamh agus tá obair déanta ag an Aire Stáit maidir leis seo. Déarfaidh mé leis go bhfuil sé práinneach go dtabharfadh sé eolas cruinn don Teachta agus don Teach.

Pat Gallagher (Donegal, Fianna Fail)
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I call the leader of the Rural Alliance, Deputy Mattie McGrath.

Micheál Martin (Cork South Central, Fianna Fail)
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That is an unexpected promotion.

Mattie McGrath (Tipperary, Independent)
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It is. Any day one gets it, one takes it. The programme for Government includes specific commitments in the health area, and Deputy Grealish has raised some matters regarding Galway. My question is about South Tipperary General Hospital. A total of 41 people are on trolleys there today, which is the highest number in the country. It is a small hospital compared to Cork University Hospital, CUH, or Beaumont Hospital, so this is totally intolerable. Despite the money announced for the winter initiative nothing has happened to help the hospital.

In spite of my colleague, Deputy Lowry, planning to helicopter in motel-type accommodation here, which is pie in the sky and which the Minister must have told him about or somebody else must have dreamt it, nothing has happened. There is a chronic situation in that hospital. If the Taoiseach and the Minister for Health are not going to open Cashel hospital, will they sell it and get a private operator to take it over and ask it to run it?

Pat Gallagher (Donegal, Fianna Fail)
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Is there proposed legislation for this?

Mattie McGrath (Tipperary, Independent)
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Of course there is. It relates to chapter 6 of the programme for Government with respect to health initiatives. There is a chronic situation in Clonmel hospital. To have 41 people on trolleys in a hospital that size is outrageous.

Pat Gallagher (Donegal, Fianna Fail)
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I thank the Deputy for his brevity.

Enda Kenny (Mayo, Fine Gael)
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I am not sure Deputy Mattie McGrath is actually proposing that move or that he is telling the people down there that the hospital should be taken over by a private enterprise.

Mattie McGrath (Tipperary, Independent)
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I am. If the Taoiseach is not going to open-----

Pat Gallagher (Donegal, Fianna Fail)
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Allow the Taoiseach to respond without interruption.

Enda Kenny (Mayo, Fine Gael)
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I will have the Minister for Health respond to Deputy McGrath on what is a valid question.

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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Page 64 of the programme for Government refers to the Government commitment to making greater use of effective but costly medicines. Page 33 of the Health Service Executive service plan indicates that 2016 will see new drugs being a significant feature. At the weekend we saw press reports that the decision has already been made not to make the game-changing and life-saving drug Orkambi available to those of the 1,200 cystic fibrosis sufferers in this country who are suitable to be treated with it.

I ask that a decision be made in the same vein as that made previously by the then Minister, the former Deputy, James Reilly, when he, despite a decision by the National Centre for Pharmacoeconomics, NCPE, and the committee within the HSE not to provide the drug Kalydeco to relevant and suitable patients, overruled that decision at the time and made it available. I ask that the Government immediately move to make a decision and direct that Orkambi be made available to those patients who require it such as that of the Golden family in Sligo whose daughter, Grainne, sadly passed away as a very young girl some 12 months ago. Her dying wish was that other children would not have to go through the same suffering and experience the same fate she had.

If it is merely the cost of the medicine rather than the value of life, I would make a simple point. The cost of acute beds per day is between €1,000 and €1,200. Many cystic fibrosis patients at their sickest spend up to nine months per year in an acute bed. At that cost, that works out between €270,000 and €324,000 per year. To provide this game-changing and life-saving drug to those people at a cost of €160,000 would be between 49% and 59% of the cost of providing the acute care that we are providing. In essence, it would be cost saving and free up many of the acute beds we heard Deputy Grealish and my leader, Deputy Micheál Martin, highlight as needing to be freed up because of the waiting list throughout the country. I appeal to the Taoiseach to take the right and just decision in this instance.

Enda Kenny (Mayo, Fine Gael)
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This is a matter that is of considerable stress and interest to those who suffer from cystic fibrosis for whom this might be an improvement in the quality of their lives. The company involved, Vertex, needs to be realistic in respect of what it is charging. The Minister, Deputy Harris, is not alone in his difficulties in respect of Orkambi for cystic fibrosis patients. The same situation applies in Australia, Canada, England and Scotland where this drug has not been approved as part of the public health system. The Minister has written to all the other Ministers for health in those countries seeking their co-operation in joining in a realistic set of discussions with Vertex in order that they can positively influence this drugs company to be more realistic in what it is demanding.

The Minister has also invited Cystic Fibrosis Ireland for an up-to-date briefing on where the process is at now. He has been in touch with Opposition spokespersons about this. However, as Professor Barry said yesterday, it is time for the company to put patients first and to reduce its price significantly. A five-year gross budget impact would be almost €400 million and the NCPE noted the significant opportunity cost associated with reimbursing the drug. We are fully supportive of the discussions that need to take place directly with the company on a renewed basis. These are not political decisions. Politicians are not in a position to be qualified to make the clinical judgments as to the extent of improvement in the quality of life for the patient and the cost that is being charged.

The HSE has been involved with Vertex since June of this year. It is disappointing that Vertex has given no ground. I have the letter here from the Minister for Health to the Australian Minister asking that people would get together in a number of countries and talk to Vertex in this respect. The NCPE which undertook the assessment of Orkambi noted that the drug was not considered cost-effective at the price of almost €160,000 per patient per year as submitted by the manufacturer. The clinical assessment of the NCPE estimated that the cost-effective price in this instance was closer to €30,000 or five times less than what the company is demanding. The five-year gross budgetary impact would be almost €400 million and, therefore, the company needs to be realistic in its discussions with the HSE based on the professional clinical assessment of the value of the drug in terms of the improvement of the quality of life of the patient. The other countries I have mentioned are in the very same boat. This drug has not been approved on the public health system for cystic fibrosis sufferers in those countries. I hope that Vertex becomes realistic in its discussions about the price it is demanding and what might be more appropriate, which would not only allow cystic fibrosis sufferers to benefit from Orkambi but many others to benefit from other drugs as well. I hope the discussions take place again quickly. The Minister will brief cystic fibrosis sufferers to give them the up-to-date position.

Carol Nolan (Offaly, Sinn Fein)
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I want to raise again with the Taoiseach the issue of school transport again. I raised the issue a month ago and was told the findings would be published. We still have no findings. I attended a meeting with Bus Éireann officials last week along with the Minister of State at the Department of Education and Skills, Deputy Halligan, and many other Deputies from rural constituencies who are experiencing serious problems with this issue. The meeting was nothing more than a deflection from the real issues at play. The meeting was to discuss communication problems between public representatives and Bus Éireann. This is not good enough. The elected members of Edenderry municipal district in County Offaly wrote to the Minister of State about this issue at least one month ago but they have received no reply. This is another example of rural neglect. These are rural communities with no public transport. Children are being dropped off at school at 7 in the morning and this is just not good enough. We need the review published as soon as possible because this issue is unacceptable and it will not go away. I will keep agitating.

Enda Kenny (Mayo, Fine Gael)
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The Minister of State, who is dealing with this, is not present. Perhaps the Minister for Education and Skills might like to comment on it.

Richard Bruton (Dublin Bay North, Fine Gael)
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This scheme has a budget of €175 million. Under it, there are guaranteed places for people who fall within the eligible categories and, after that, concessionary places are made available. We have maintained a high level of commitment in this area but most of the requests are for people to move outside the established rules. The Minister of State has undertaken to examine it and he has sought with Opposition Members to find resolutions but these are not easy to find. That is why it is taking considerable time to consider this.

Pat Gallagher (Donegal, Fianna Fail)
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I call Deputy Healy-Rae and ask him to remember that Deputy Durkan needs time to ask his question.

Danny Healy-Rae (Kerry, Independent)
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I have to raise again the serious problem of elderly people in County Kerry waiting for cataract operations. I have raised this many times previously and, indeed, Deputy Michael Healy-Rae has raised it as well. It is just not good enough. We have five Ministers for health and we have a raft of HSE managers, yet many elderly people will not be able to see this Christmas-----

Pat Gallagher (Donegal, Fianna Fail)
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Indicate to the Taoiseach-----

Danny Healy-Rae (Kerry, Independent)
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Just one second. They have to wait for a year and a half to two years for an operation that takes little over an hour. It is very unfair to leave people blind in the latter days of their lives for so long. We have five Ministers for health. If they are not able to deal with the problem - I have it raised many times before - they will have to pull out because they cannot give people a simple operation. What will they do about it? Will this be left-----

Pat Gallagher (Donegal, Fianna Fail)
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If the Deputy continues, I will not be able to allow the Taoiseach to reply.

Danny Healy-Rae (Kerry, Independent)
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I am sorry.

Pat Gallagher (Donegal, Fianna Fail)
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Do not be sorry. The Taoiseach has seven seconds to reply.

Danny Healy-Rae (Kerry, Independent)
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It is very bad for people.

Pat Gallagher (Donegal, Fianna Fail)
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The Deputy has to consider that I cannot overrule the Order of Business, even for the Taoiseach. The Taoiseach has five seconds.

Enda Kenny (Mayo, Fine Gael)
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It can be very debilitating for an elderly person who is unable to read or watch a television because of cataracts. They take time, though, to be appropriate for an operation. I will have the Minister for Health look at the waiting list in Kerry and advise the Deputy of what the position might be.

Pat Gallagher (Donegal, Fianna Fail)
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I will have to apologise to Deputy Durkan unless it is a short question. He is normally orderly.

Bernard Durkan (Kildare North, Fine Gael)
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When will the Garda Síochána (malicious injuries compensation) Bill come before the House?

Enda Kenny (Mayo, Fine Gael)
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Legal advice has been received on that and it is being analysed. Progress is being made and we will advise the Deputy of the up-to-date position.