Micheál Martin (Cork South Central, Fianna Fail)
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I am sure the Taoiseach will agree that central to the implementation of the programme for Government is that a Government be in place. Deputy Enda Kenny was elected as Taoiseach last May, which is not so long ago. He then put forward a number of Ministers to the House for approval, which is how it is done, and they were approved by the House. In the past week, quite a number of the Ministers nominated by the Taoiseach have publicly set a timeline for his leaving office. I put it to the Taoiseach that if there were to be a change, it could presage his having to come before the House again. If new Ministers were to be appointed, they would need the approval of the House. This is central to the implementation of the legislation planned under the programme for Government. I argue that if there are any plans to make such changes, perhaps the Taoiseach owes it to the House to make it aware, first and foremost, of anything that might change the position regarding the implementation of the programme for Government or the Government line-up, as opposed to that of just one political party. This matter is central to the entire Dáil, which, constitutionally, is the Chamber that approves the Government and elects a Taoiseach, who then nominates Ministers for approval. Quite a number of Ministers have publicly set out the Taoiseach's timetable for his departure from his office. I appreciate that it may not be the same as his timetable. Nonetheless, if he has any information-----

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Deputy's time is up.

Micheál Martin (Cork South Central, Fianna Fail)
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I appreciate that. If the Taoiseach has any information in this regard, I would appreciate it if he would relate it to the House.

Enda Kenny (Mayo, Fine Gael)
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I assure Deputy Micheál Martin that no change in the Government is proposed. The Government is a minority partnership Administration made up of the Fine Gael Party, the Independent Alliance and a number of other Independents and supported by our confidence-and-supply agreement with Deputy Micheál Martin's party. The Deputy has made it perfectly clear that he intends to adhere to the agreement. The Government has a serious agenda in its programme for Government regarding the work of all Ministers in their contact with their counsel in regard to Brexit, trade missions and other activities as part of the programme for Government. There is no change in this regard. One can have opinions one way or the other. The position is that Government is focused on doing the job for the people and the country, as was our remit when we were elected.

Gerry Adams (Louth, Sinn Fein)
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The Fianna Fáil leader is right that any new Taoiseach will have to be approved by the House. However, given that Fianna Fáil has already pledged support, it will just be a rubber-stamping exercise.

I wish to raise the issue of the treatment of cystic fibrosis and the controversy surrounding Orkambi and whether the HSE will agree to make it available to hundreds of patients. New evidence has emerged to support the case for approving Orkambi and, according to Cystic Fibrosis Ireland, this new data shows Orkambi will save the health system even more than previously estimated. Whatever decision the HSE makes, the ultimate decision will rest with the Minister and the Government. Could the Taoiseach update the Dáil on the status of negotiations with Vertex? Many families are dependent on the outcome of this. Has the Government carried out a cost analysis on the procurement of Orkambi and the money that could be saved, as it is claimed, through a reduction in hospital admissions?

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Deputy's time is up. On the same issue, I call Deputy O'Dea.

Willie O'Dea (Limerick City, Fianna Fail)
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The Taoiseach will recall that it is almost three months since there was a very moving demonstration outside the front gates of Leinster House. I attended a candle-lit vigil in the rain in Limerick on Friday night with parents of children suffering from cystic fibrosis. They told us that since that demonstration outside Leinster House, several children have died for want of the drug in question. When will there be a resolution of this issue and when will this drug be made available to people who are literally fighting for their lives?

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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On the same issue, many of us have attended various candle-lit vigils. There will be a briefing in the House tomorrow and I gather there will be a national protest outside the complex on Wednesday next. It would be wonderful if, as a collective, we could take a decision next week to make that protest a celebration.

As we continue to procrastinate, sick children are getting sicker and some will die. My understanding, having spoken with Vertex, is that this decision is somewhere between the board of the HSE and Cabinet. We do not have to wait for a meeting to be scheduled. Can the Taoiseach not knock heads together this week with the young Minister for Health, Deputy Harris, whom he mentioned earlier, and take a decision on this matter? Vertex has put forward a proposal which includes the provision of that drug immediately to all patients and the provision of drugs that are being developed for the same price and the same agreement. There is no excuse for continuing delays.

Enda Kenny (Mayo, Fine Gael)
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I met Aisling and people from Sligo-Leitrim in Sligo recently at a candlelight vigil relating to Orkambi.

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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I was there.

Enda Kenny (Mayo, Fine Gael)
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Deputies O'Dea and MacSharry are well aware that the Minister and the Cabinet of the day do not make the clinical decision on any drug. The HSE has re-entered talks with Vertex.

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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With respect, the talks are over. It is with the board of the HSE.

Enda Kenny (Mayo, Fine Gael)
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Reports that they were ended are not correct. The fact is that the National Centre for Pharmacoeconomics, NCPE-----

Micheál Martin (Cork South Central, Fianna Fail)
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The talks are over.

Enda Kenny (Mayo, Fine Gael)
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-----which is completely independent in the way it judges the improvement in the quality of life for any drug to be given to any patient – and I regret of course, and sympathise with those, where the death of anybody has occurred, never mind children – undertook the assessment of Orkambi and noted that the drug was not considered cost-effective at a price of €160,000 per patient per year as submitted by the manufacturer.

Willie O'Dea (Limerick City, Fianna Fail)
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The matter has moved on since then.

Enda Kenny (Mayo, Fine Gael)
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It is not somewhere between the committee and the Cabinet.

Micheál Martin (Cork South Central, Fianna Fail)
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It is.

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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It has gone way beyond that. It is with the board.

Micheál Martin (Cork South Central, Fianna Fail)
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It has been three months.

Enda Kenny (Mayo, Fine Gael)
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If the recommendation of the NCPE is that it accepts that the price being offered or mooted by Vertex is in the interests of the patients to improve the quality of their lives-----

Willie O'Dea (Limerick City, Fianna Fail)
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We understand the system.

Enda Kenny (Mayo, Fine Gael)
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------and that comes to the Minister for Health and the Cabinet with a recommendation that is positive, that is what we will act on. We do not make the decisions.

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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While considering other timelines, can the Taoiseach prioritise this issue because people are dying?

Enda Kenny (Mayo, Fine Gael)
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We do not make the decisions about the improved quality of life for any patient. I understand this and mentioned it to the people whom I met in Sligo.

Micheál Martin (Cork South Central, Fianna Fail)
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It has moved on from there. They have had their negotiations.

Enda Kenny (Mayo, Fine Gael)
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The NCPE has provided very clear guidance on a price that is considered fair and cost-effective to deal with the improvement in the quality of life.

Willie O'Dea (Limerick City, Fianna Fail)
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We know that.

Enda Kenny (Mayo, Fine Gael)
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Vertex needs to come back. I do not know where it is now with its offer.

Marc MacSharry (Sligo-Leitrim, Fianna Fail)
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It is waiting for an answer.

Seán Fleming (Laois, Fianna Fail)
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The Taoiseach does not know anything about the matter. He does not know where it stands.

Enda Kenny (Mayo, Fine Gael)
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The NCPE is the independent body that will make the clinical decisions-----

Micheál Martin (Cork South Central, Fianna Fail)
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This is the old conversation from three months ago.

Enda Kenny (Mayo, Fine Gael)
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-----about this or any drug and it is not in the hands of the politicians to say whether this is a fair price.

Willie O'Dea (Limerick City, Fianna Fail)
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The Taoiseach is sitting on it. When is he going to make a decision?

Enda Kenny (Mayo, Fine Gael)
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The NCPE makes the assessment on the basis of the cost being put forward by the company-----

Willie O'Dea (Limerick City, Fianna Fail)
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When?

Micheál Martin (Cork South Central, Fianna Fail)
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The Taoiseach should check it out

Enda Kenny (Mayo, Fine Gael)
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-----in terms of the improvement of the quality of life of the children or patients as the case might be.

Brendan Howlin (Wexford, Labour)
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The Women in Work Index has found a 14.8% difference in median pay between men and women. In other words, a woman working a 40 hour week effectively works the final six hours for free. The time is long past, and I think everybody in this House would agree, when men should automatically be paid more than women. Will the Taoiseach support yesterday's call by the trade union IMPACT for legislation requiring employers to publish details of the gender pay gap within their companies? Will he indicate that if we produce such legislation he will support it? In its programme for Government, this Administration promised to strengthen the role of the Low Pay Commission in respect of the gender pay gap. What specifically is it doing to implement that commitment?

Enda Kenny (Mayo, Fine Gael)
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I would like to study the report. I think the point made by Deputy Howlin is self-evident. I understand that the Low Pay Commission has to bring forward recommendations in the not too distant future based on its assessment of where we should be now. I am quite sure it has taken the Deputy's point into account. Clearly, the day when women, as against men, were expected to work six hours for nothing has long since passed. I would like to study the report. It will be discussed by the Cabinet. We look forward to hearing what the Low Pay Commission's next recommendation is and what it is based on.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I call Deputy Coppinger.

Ruth Coppinger (Dublin West, Anti-Austerity Alliance)
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I did not indicate but I was planning to do so.

Willie O'Dea (Limerick City, Fianna Fail)
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I wonder why the Ceann Comhairle assumed the Deputy had done so.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Deputy Coppinger did indicate.

Ruth Coppinger (Dublin West, Anti-Austerity Alliance)
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Nevertheless, I would like to know when the Government intends to introduce the legislation that is clearly needed to deal with what is happening in Tesco. I welcome the Sinn Féin Bill on the right to representation, which is to be proposed in this House later in the week. When will the Government bring forward legislation on the rights of workers in this country? Is the Government planning to do anything about Project Black, which involves the hiring by Tesco of an international union-busting legal firm? Apparently, the stated intention of Tesco, which is the biggest private sector employer in the State, in pursuing this project is to increase the profit it makes in Ireland from €250 million to €500 million by doing away with the union in the company and with the workers' pay and conditions. What legislation does the Government have in mind to deal with this matter? Is it proposing to sit back obliviously and do nothing?

Enda Kenny (Mayo, Fine Gael)
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No more than in any other dispute-----

David Cullinane (Waterford, Sinn Fein)
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On the same issue-----

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I call Deputy Cullinane on the same issue.

David Cullinane (Waterford, Sinn Fein)
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As Deputy Coppinger mentioned, Sinn Féin is proposing a Bill that would, in part, deal with what is happening with Tesco and many other companies that are refusing to allow trade union access in the workplace. It is important for the Taoiseach to know that trade unions such as Mandate, Unite and the Financial Services Union and the Irish Congress of Trade Unions have given their full support to our Bill. When we have proposed Bills on workers' rights in the past, they have been rejected by Fianna Fáil and Fine Gael for political reasons. I appeal to the Taoiseach and to Fianna Fáil to support the Bill we are introducing this week and to do what is right. Can the Taoiseach provide an indication on whether the Government will support the Bill in question, which has been tabled, in part, to deal with what is happening in many workplaces across the State?

Enda Kenny (Mayo, Fine Gael)
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I hope the issue of the workers in Tesco can be sorted out by people continuing to engage in discussions and negotiations on their differences of opinion. I understand that the stores are open. This issue needs to be resolved and the capacity is there to do that. I do not support the Sinn Féin Bill because it would seriously undermine the voluntary concept of industrial relations we have in this country. A variety of other reasons for not supporting it will be spelled out by the Minister when the matter is discussed in the House.

Ruth Coppinger (Dublin West, Anti-Austerity Alliance)
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The Taoiseach is saying that people can be in a union but that it does not mean anything.

Enda Kenny (Mayo, Fine Gael)
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Deputy Cullinane is quite entitled to bring forward the Bill. I think that when the arguments are put forth here-----

David Cullinane (Waterford, Sinn Fein)
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The Taoiseach supports the employers. He is siding with the employers again.

Enda Kenny (Mayo, Fine Gael)
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The Deputy is talking about a serious change in the volunteer concept of industrial relations-----

The Taoiseach: It is clear that the Deputy is talking about a serious change in so far as the volunteer concept of industrial relations is concerned.

Ruth Coppinger (Dublin West, Anti-Austerity Alliance)
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It is not a serious change.

Enda Kenny (Mayo, Fine Gael)
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-----and in the scale of activity of multiple unions in any business. It is worthy of a good discussion, but I do not support it.

Ruth Coppinger (Dublin West, Anti-Austerity Alliance)
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Shock horror.

Mattie McGrath (Tipperary, Independent)
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My colleague, Deputy Danny Healy-Rae, and many other Deputies raised the delays in GLAS payments in the House a few weeks ago. Huge fines, penalties and levies are imposed on people who cannot pay their taxes. It was not good enough for the Minister, Deputy Creed, to say in this week's Irish Farmers Journalthat these delays have been caused by technical hitches. He told Deputy Healy-Rae a few weeks ago that there was a computer glitch. It is not acceptable. Farmers are decent people who pay their bills. They like to pay the people they hire in to do work. Now those people cannot get paid. Farmers are embarrassed out of their minds because they need the grant money, to which they are entitled for environmental reasons, to pay the bills of people they have employed. They are in the invidious situation of waiting for money from the Department of Agriculture, Food and the Marine. Computer glitches and technical hitches are no good to them. They want the money to which they are entitled. Everything was approved before they started. This is a nonsense. Revenue imposes penalties and penal rates of interest on people who fail to pay their taxes, but farmers and others who are waiting for money from the State cannot get anything. It is totally unacceptable.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I call Deputy Murphy O'Mahony on the same matter.

Margaret Murphy O'Mahony (Cork South West, Fianna Fail)
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The programme for Government contains a commitment to secure farm incomes. How can the Taoiseach stand over the delays in the payment of compensation to tillage farmers in the constituency of Cork South-West? Like other farmers throughout the country, they are also waiting on their GLAS payments.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I call Deputy McConalogue on the same matter.

Charlie McConalogue (Donegal, Fianna Fail)
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I would like to ask the Taoiseach about the GLAS payments that were mentioned by Deputy Mattie McGrath and the tillage compensation that was mentioned by Deputy Murphy O'Mahony.

The Minister, Deputy Creed, is in danger of getting a slot or a call-up by Mr. Joe Schmidt for this weekend's match because of his considerable talent at kicking to touch the issue of a tillage fund. We had a vote in the Dáil and he committed to a tillage forum to examine how a fund could be put in place. From that last week we still have not got any further progress. Further to Deputy Murphy O'Mahony's comments, will there definitely be a tillage fund and will the Taoiseach and the Minister, Deputy Creed, ensure the fund is put in place as soon as possible?

Enda Kenny (Mayo, Fine Gael)
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I am sure the Minister will follow through in his comments about a tillage fund. I say to Deputy Murphy O'Mahony and any other Deputies raising the question of GLAS payments that payments of any grants from any Department depend on two factors: availability of money and eligibility or conformity with the conditions.

Robert Troy (Longford-Westmeath, Fianna Fail)
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They are eligible.

Danny Healy-Rae (Kerry, Independent)
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These people are eligible.

Enda Kenny (Mayo, Fine Gael)
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I am sure the Minister for Agriculture, Food and the Marine is not saying some payments cannot be made because of some technical hitch. There must be a reason for this. The money is in place and the applications have come in. Do they conform with the requirements for release of the money? These payments have been made in the vast majority of cases and I am quite sure the Minister for Agriculture, Food and the Marine and his staff are working very hard to see that the remaining payments are made. They were put in place in the first place in order that the farmers could apply for and draw down assistance from the State, which was very hard-won in the first instance. We want that to be able to continue to guarantee incomes. That is why in the budget the Minister for Finance introduced the position that when there are exceptional years, such as that seen by tillage farmers in 2016, a gap year would be allowed for recovery. The farmers were not able to get crops from the fields in the first place.

Eoin Ó Broin (Dublin Mid West, Sinn Fein)
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The programme for Government and the housing action plan of the Minister, Deputy Coveney, include commitments to strengthen tenants' rights. As the Taoiseach knows, the Residential Tenancies Act 2004 created what is now the Residential Tenancies Board which mediates in disputes between landlords and tenants when either side is not adhering to legal obligations. Local authority tenants are not included under this legislation, unlike tenants from private rentals and approved housing bodies. Will the Taoiseach bring forward legislation to give local authority tenants exactly the same legal protections as those living in the private rental and approved housing body sector to ensure they have access to the Residential Tenancies Board?

Enda Kenny (Mayo, Fine Gael)
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That was enacted in 2004. If those people are to be included in its remit, an amending Bill would have to be introduced. I will have the matter examined and I will advise the Deputy on that.

Bernard Durkan (Kildare North, Fine Gael)
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There is the issue of expensive drugs for deserving patients. To what extent, if any, is there application of the Single Market in this regard right across the European Union? Has it been done already or can it be done? Have comparisons been made of the difference between servicing the costs and needs of individual patients in this country and patients in other European countries? The Single Market should apply but could it be applied in this regard?

Enda Kenny (Mayo, Fine Gael)
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Ireland is often used as a reference point. The House is aware that the Minister for Health has been working with a number of other health Ministries in different countries to deal with the pharmaceutical companies in terms of getting best value for taxpayers' money for patients suffering from particular conditions or who must contend with particular challenges. He is working within that sphere. With regard to particular drugs, the National Centre for Pharmacoeconomics is working with Vertex and I hope this matter can be agreed and resolved in order that the children and patients with cystic fibrosis may have the benefit of improving quality of life arising from distribution of the drug involved.

Eamon Ryan (Dublin Bay South, Green Party)
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A Programme for Partnership Government has indicated that a key reform in delivering its actions is the establishment of a fully resourced independent budget office within the Oireachtas, available to all Members. It is indicated that this is a key reform to making the working of the Government more effective and transparent, giving Members a greater say in the development of budgets. I am on the Committee on Budgetary Oversight and we are deeply concerned that we have no sight of the office being set up. It was recommended in the early autumn and nothing is happening.

I understand the Department of Public Expenditure and Reform has done the classic hatchet "Yes Minister" job in saying it will not agree any position above a principal officer level, whereas most of the committee and this House believe this must go to assistant secretary level. I am interested to hear the Taoiseach's view. We need an office with real authority, skills and knowledge. Does the Taoiseach agree we require this sort of level?

Does the Taoiseach agree it is a disgrace that, as we start the new budget cycle, the budget oversight office is not in place? What could the Taoiseach's office do to convince the Department of Public Expenditure and Reform to stop acting in this "Yes Minister" mode by stalling this critical piece of Oireachtas reform and to let us see it happen? We have not even advertised it. We are starting the new budget process and we do not have the offices in place which we need to do our job properly.

Enda Kenny (Mayo, Fine Gael)
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The Ceann Comhairle and his office are working on it. It is part of the programme for Government and, therefore, should be attended to. There is no point in setting up an ineffective office. In discussions, the appropriate level of status, remuneration and facilities should be made available. From my Department, we will see what we can do to expedite it in accordance with the work and discussions the Ceann Comhairle has had.

Robert Troy (Longford-Westmeath, Fianna Fail)
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There is a crisis in our health service regarding hospital bed shortages. Today, a young lady in her 40s has been discharged from Mullingar hospital because there is no bed for her in the Mater hospital. Her consultant at Mullingar hospital said her heart was failing at an alarming rate. If she does not get access to a bed for a life-saving procedure in the Mater hospital, she is going to die. This is a damning indictment of the health services policies the Government is pursuing. What can the Taoiseach do for this lady whose life will be saved if she gets the necessary procedure, but for whom there is no bed in the Mater hospital today?

Enda Kenny (Mayo, Fine Gael)
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I do not know the details of the case the Deputy mentioned. It is obviously a stressful time for the person involved. I am not aware whether any other specialist cardiac unit could do the same operation and has a bed available. These decisions are made by consultants and clinical people as to the priorities. I hope the matter can be dealt with, that a bed can be found for the young woman and that she can receive her life-saving treatment. If the Deputy gives me the details later, we can have them assessed.

Seán Fleming (Laois, Fianna Fail)
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A while ago, the Government announced a mid-term review of its capital investment plan. Since that announcement, Members all have become aware of possible overruns of €600 million regarding the national children's hospital at St. James's and €200 million regarding moving the National Maternity Hospital to St. Vincent's. This is in addition to the plan stating that the Rotunda Hospital is to be moved to Blanchardstown and the Coombe to St. James's. In Limerick, the maternity hospitals are to go to the University of Limerick. This morning, the HSE chief executive was quoted as saying he needed €9 billion to renew old equipment. In addition, there are priorities for mental health, cancer care and community services. In view of the overruns, one can only conclude that the current plan bears no relation to reality and the funding available. When will we see a new plan, will it be an honest document and when will it be published?

Enda Kenny (Mayo, Fine Gael)
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The process has begun. The Deputy mentioned the national children's hospital. Permission was granted in April 2016 and €650 million of Exchequer funding was approved for it in 2014. This was for the core construction of the new national children's hospital with the two paediatric outpatient units and the urgent care satellite centres on the campuses of Tallaght and Connolly hospitals. This funding was approved following a cost estimate which began in 2013, four years ago, and completed in early 2014. At that time, construction inflation was estimated to be approximately 3%. The pricing proposed by the tenderer took account of construction inflation which is now running at more than 9%, the extended project timeline, now scheduled to be completed in 2021, and the final market cost of the build. The final proposed cost is within 5% of projections and the successful party was the one with the most competitive tender. There is a monitoring committee to deal with the cost, which will be a contract cost, for the national children's hospital.

The review will be ready by the middle of the year so as we approach the 2018 budget, the analysis of the capital expenditure programme should be available to the Minister. Beyond that, we must examine where we are for the next ten, 15 or 20 years, to an Ireland which will have 1 million more people and a requirement for 500,000 jobs and 500,000 houses.

Where are they going to live and work and how are they going to travel? It is about communications facilities, schools and hospitals. People say that we need six new hospitals and that a new one has not been built since 1998. Clearly the National Children's Hospital and the National Maternity Hospital are part of this. If the HSE says it needs €9 billion, we could probably double that figure and we would still need more. We need facilities for our people for the next 20 to 50 years and this is part of the immediate review and in the longer term.

Imelda Munster (Louth, Sinn Fein)
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I wish to raise the issue of social and health care services for people who have an intellectual disability, particularly in light of the financial misappropriations at St. John of God's in Drumcar where residents had money taken from their personal bank accounts to purchase medical supplies that St. John of God's should have purchased. One resident also had his own personal bank account raided to purchase cutlery, soft furnishings and a fireplace for the St. John of God's. Given the apparent lack of oversight, or any scrutiny at all by the HSE, despite the fact that millions upon millions of euro in public money is paid into this service, will the Taoiseach give a commitment to publish the audit of St. John of God's that is currently being carried out in the interests of transparency and because it is funded with public money?

Enda Kenny (Mayo, Fine Gael)
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It appears to be more than borrowing from patients' personal bank accounts if what Deputy Munster is saying is true. Obviously, the Minister for Health will deal with this matter. If he has not had the report by now, he will deal with it when he has had time to reflect on it. Clearly we cannot have a situation where patients' private bank accounts are raided to pay for public property in any facility. That is a crime. I will ask the Minister for Health to respond to Deputy Munster in this regard.

James Browne (Wexford, Fianna Fail)
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Under the programme for Government commitments were made to mental health matters and, similarly, in the confidence and supply arrangement, implementation of Vision for Change for mental health was a condition of support for the Government. In a letter released over the weekend to Deputy Howlin and me from the Mental health Commission, it is clear that the imminent closure of somewhere between all and the majority of the mental health beds in the acute unit in Waterford Regional Hospital will leave a population of almost 300,000 people with potentially not one single acute unit bed in the south-east. What is the Taoiseach going to do about meeting these commitments to support people in the south-east and mental health?

Enda Kenny (Mayo, Fine Gael)
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I am not aware of the letter received by Deputies Howlin and Browne, but obviously Deputy Browne is in discussion with the Minister for Health directly and the Minister of State with responsibility for mental health. I will have the matter raised with the Minister and I will respond to Deputies Browne and Howlin.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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That concludes Questions on Promised Legislation. My apologies to the ten Deputies whose questions were not reached.