Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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8. To ask the Taoiseach if the Cabinet committee on health has met recently. [8468/17]

Joan Burton (Dublin West, Labour)
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9. To ask the Taoiseach when the Cabinet committee on health last met. [10022/17]

Gerry Adams (Louth, Sinn Fein)
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10. To ask the Taoiseach when the Cabinet committee on health last met; and when it is scheduled to meet again. [10132/17]

Enda Kenny (Mayo, Fine Gael)
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I propose to take Questions Nos. 8 to 10, inclusive, together.

The Cabinet committee on health last met on 2 February. It will meet again on 21 March.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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If the Cabinet committee on health is worth anything at all, it should be concerned, as a priority, with the extreme suffering of people in this country who need urgent medical help. Has the committee discussed the situation of Sarah-Ann Mitchell and the promise made three weeks ago by the Minister for Health, Deputy Harris, to meet her mother, Karen? Sarah-Ann is suffering from scoliosis and her situation is deteriorating while she awaits an operation. Karen is now wondering whether the Government has simply decided to ignore her daughter's situation and her own plea that the Government not only help Sarah-Ann but go further by introducing a preventative programme of screening to avoid the same happening to other children in the future.

Another case of extreme suffering is that of Ms Vera Twomey and her daughter, Ava. Yesterday the Taoiseach misinformed the Dáil that no application had been submitted for the use of a medicinal cannabis product to alleviate Ava's suffering. That is not true, as I have double checked with Ms Twomey to confirm. An Irish-registered doctor submitted the application, which is what the Minister of State at the Department of Health, Deputy Finian McGrath, told us on 15 November was necessary to be done. Furthermore, the paediatric neurologists who are treating Ava wrote in support of that application, stating their opinion that the product being sought is alleviating Ava's suffering. Why has the Taoiseach moved the goalposts in this regard and why is he playing politics with Ava Barry's very serious condition? Why is he playing politics in terms of progressing the legislation which is clearly necessary given the chill factor that is preventing medical practitioners in this country from prescribing health products that could alleviate the suffering of people like Ava? All this is down to the refusal to lift the ban on those products. Will the Taoiseach ensure the Minister for Health issues a licence for Ava Barry to avail of the product her doctors have requested? Will he, in addition, allow Deputy Gino Kenny's Bill to go to Committee Stage?

Enda Kenny (Mayo, Fine Gael)
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It is Deputy Boyd Barrett who is playing politics here.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I most certainly am not.

Enda Kenny (Mayo, Fine Gael)
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He has chosen to raise individual cases, as is his right, in the Dáil.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I do so at the request of the parents whose children are suffering.

Enda Kenny (Mayo, Fine Gael)
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The Deputy is fully entitled to talk directly to the Minister for Health about any of these serious cases, some of which were raised in an RTE programme some weeks ago. I cannot give the Deputy details regarding Sarah-Ann Mitchell's case, but I will have the Minister respond to him. Reduction of waiting times for scoliosis patients is a major priority for the Minister and he recently met with representatives of the Health Service Executive, the National Treatment Purchase Fund, senior officials in the Department of Health, the CEO of Crumlin hospital and the CEO of the children's hospital group to discuss how it can be achieved. As a result, additional theatre capacity is being provided for scoliosis procedures at Crumlin from April and an orthopaedic post at the hospital will be filled by June. An action plan for scoliosis will be presented to the Minister shortly. In addition, the NTPF, at the Minister's request, will audit practices at each of the hospitals highlighted by the individual cases featured in the "RTE Investigates" programme and report directly to the Minister on its findings.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Minister promised action would be taken three weeks ago.

Enda Kenny (Mayo, Fine Gael)
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In regard to the medicinal cannabis application, as I pointed out earlier, the Minister does not need legislation to approve an application provided there is a prescription request from a paediatric neurosurgeon.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The goalposts have been changed.

Enda Kenny (Mayo, Fine Gael)
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Deputy Boyd Barrett indicated that more than one neurosurgeon has stated in writing that the product in question is alleviating the child's condition. I do not have that clinical evidence here. The Minister confirmed this morning in answer to questions on legislation that, within the existing legal structure, he still requires a prescription to be directed by a paediatric neurosurgeon.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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That is not what the Minister of State told us in November.

Enda Kenny (Mayo, Fine Gael)
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I am not speaking for whomever the Deputy is speaking for. I heard the Minister clarify this very clearly this morning. He further indicated his intention to introduce a compassionate structure for prescribing of medicinal cannabis but that this would still require its authorisation being approved by a paediatric neurosurgeon. These are issues that are outside the range of politicians, as the Deputy is well aware. While an application has been lodged by a doctor in the individual case to which he referred, it requires the sanction of a paediatric neurosurgeon to progress such an application.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The application was submitted by an Irish-registered doctor, which is what the Minister of State, Deputy Finian McGrath, told us last November is required.

Enda Kenny (Mayo, Fine Gael)
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The same applies in respect of any other application, but the doctor is not the person who approves it in this instance. It is required to be approved by a paediatric neurosurgeon. The Deputy may speak to the Minister directly about this, but he clarified it here this morning.

Joan Burton (Dublin West, Labour)
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On the same point, both Deputy Boyd Barrett and I took part in the debate with the Taoiseach on these matters last November. In fairness to him, the Taoiseach responded quite sympathetically to the concerns we raised. I referred then to the case of a nine year old girl who has severe scoliosis and an intellectual disability and is a wheelchair user. One can only imagine the level of pain she is suffering and the difficulties for her family. The Taoiseach or the Minister must explain in detail precisely what is being done to tackle this issue. It is way beyond politics and concerns the welfare of children and families. We are not getting any answers from the Minister.

I wish to raise the issue of the children's hospital building project, which is very relevant to the issues referred to by Deputy Boyd Barrett. The management of the project has stated that one of the reasons the costs have escalated so dramatically is the rise in annual construction inflation from 3% to 9%. Apparently, the estimated cost increase, potentially from €1 million to closer to €2 million per bed, is because of this inflation. I have searched the available construction data and can find no evidence of an inflation rate of 9%. In fact, I cannot even find a reference to 3%. Will the Taoiseach indicate the construction workers who received a wage increase of 9% last year and this year? I do not know who they are.

Whether St. James's Hospital or Connolly Hospital is chosen as the location for the children's hospital - there has been expert advice to the effect that the latter would be much cheaper at this point - in both cases, the sites are free. I realise the people involved in the project are very well-meaning but we must have answers to these questions. If the Cabinet committee on health is to have any useful purpose, surely it will examine this issue? What is the reason for the massive increase in the cost of the project? Can we have clarity on the claim that there was a rise in construction costs inflation from 3% to 9%?

2 o’clock

There is no evidence for that anywhere that I can find.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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I have a number of questions on the Cabinet sub-committee. Was there a discussion on the growing number of children on the waiting list for scoliosis treatment? The House has debated that matter, but action has not been taken. Is the Taoiseach satisfied that the new theatre in Our Lady's Children's Hospital, Crumlin, will be in operation in June and that sufficient nurses will be recruited to service it? The latter is the greater question, given that theatres in the hospital have lain unused because of a lack of staff.

Will the Taoiseach indicate whether he received an update at that meeting on the status of the bed capacity review which is supposedly under way and will he share that information with the House today? When will the review be completed and, more importantly, will it be published? December was the worst month on record for the number of citizens on trolleys and 2016 was the worst year.

Did the Cabinet sub-committee discuss the proposal of the Minister, Deputy Harris, to set up the equivalent of a modern field hospital, namely, prefabs in hospitals, at a time when many hospital wards are sitting vacant because there are not enough nurses?

Was the meeting informed, or is the Taoiseach aware, of the balloting for action by Dublin Fire Brigade? Were contingency plans to deal with the withdrawal of service by ambulance and fire crews in this city discussed? Management is unwilling to negotiate directly with a service that has been up and running for 150 years and been of significant help not only to the population of Dublin but also the populations of nearby counties.

When is the next meeting of the sub-committee?

Enda Kenny (Mayo, Fine Gael)
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Well actually this is getting to the stage of utter ridiculousness, a Leas-Cheann Comhairle. I do not answer here for all of the details of the Ministry of health. In fact, I am always advised that I am not even supposed to mention what is being discussed at Cabinet sub-committees because they are sub-committees of the Cabinet and one does not discuss Cabinet business in an open forum, but they are valid questions and people have to have a facility to have them answered, and that is either by Topical Issue to the Minister for Health of the day or the Oireachtas committee that deals with health and all of the opportunities to ask these questions.

Deputy Ó Snodaigh asked me some detailed questions to which I simply could not have the answer. He asked me if the theatre was going to be ready by June. What I said in my reply was that the orthopaedic post would be filled by June. I expect that the theatre, which has been provided for for quite some time, should of course be ready to deal with children who come before the hospital for treatment in June.

The Deputy mentioned other issues there. He talked about field hospitals. What is he on about? The Minister for Health came down to Mayo general hospital and looked at the emergency department down there, not at his suggestion, but at the suggestion of the staff and the manager who run the place. They said they needed extra space there. They were very happy to say that we provided them with an expansion of space out the back adjoining the existing emergency department, which is not for overnight stays, but which will relieve the pressure and the stress and the distress upon people. To come in here and describe it as some kind of a field hospital is-----

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Just build it. If it is a prefab-----

Enda Kenny (Mayo, Fine Gael)
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This is not-----

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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-----it is permanent. We have seen that over the years.

Enda Kenny (Mayo, Fine Gael)
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Field hospitals do not appear and are not provided within hospital structures. "Prefabs" goes back to the question-----

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Neither should prefabs be.

Enda Kenny (Mayo, Fine Gael)
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-----that Deputy Ó Caoláin asked yesterday about the sort of prefab concept as something that one could put a finger through after five years 20 years ago when people built prefab dwellings or prefab school rooms.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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Exactly and they stayed for 40 years.

Pat Gallagher (Donegal, Fianna Fail)
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The Taoiseach without interruption, please.

Enda Kenny (Mayo, Fine Gael)
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They are all gone. The last Government eliminated all of the prefabricated school buildings. What is being provided in south Tipperary and in Mayo general is not that kind of prefab. It is a place where people will be able to go and have attention given to them - medical attention that they need - in very comfortable surroundings and they will not have to stay overnight on any trolley.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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It is not a purpose-built hospital.

Pat Gallagher (Donegal, Fianna Fail)
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Did the Taoiseach address Deputy Burton's question?

Enda Kenny (Mayo, Fine Gael)
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I might just say that, in respect of the children's hospital-----

Pat Gallagher (Donegal, Fianna Fail)
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Will the Taoiseach address Deputy Burton's question now so that we can move on?

Enda Kenny (Mayo, Fine Gael)
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I will. The figure of €650 million relates to Exchequer funding that was approved when Deputy Burton was in government in 2014 for the core construction of the new national children's hospital, together with the two satellite centres. She was at the Cabinet table when that decision was made, and that does not include equipment, commercial spaces or educational facilities for students, as those elements were always to be funded and to be procured separately. That funding was approved following a cost estimate that commenced in 2013, which was completed early in 2014. At that time, construction inflation was estimated at 3%. The pricing proposed by the tenderers did take account of current construction inflation, which is now running higher than 9%.

Joan Burton (Dublin West, Labour)
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Where is the evidence of that?

Enda Kenny (Mayo, Fine Gael)
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That does not mean a 9% increase in wages. It takes into account the extended projected timeline to 2021 and the final market cost of that build. The costs set out, for Deputy Burton's information, in the final project brief consist of the design brief, the definitive business case and the project execution plan. They provide for the construction of the core hospital and the satellite centres. They include provision for VAT, risk provision, inflation provision, all fees, decant, external works, enabling costs and project management costs for a building that will cater for 25% of our population for the next 50 years. This also includes commercial spaces like the underground car park, retail space, higher education spaces, the children research and innovation centre and equipment.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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I am sorry, but they were excluded.

Pat Gallagher (Donegal, Fianna Fail)
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We must move on.

Enda Kenny (Mayo, Fine Gael)
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It also covers some shared infrastructure and services that will be used by both St. James's and the Coombe Women and Infants University Hospital when all three hospitals are on the one campus, thus avoiding duplication of services in the future.

The updated costs, finally, have been incorporated into the final project brief and were submitted to the HSE for review and the HSE has now submitted that final brief to the Department of Health. The Minister intends to bring a memo to Government very shortly - in the coming weeks - on the new children's hospital. This will be the major health building in this country of the last 100 years and it is in addition to the long discussions that have thankfully ended in respect of the moving of the National Maternity Hospital out to the site at St. Vincent's, but this will not be finished until 2021. It is really and truly a world-class piece of infrastructure and investment in the children of the nation. There is a very, very specific committee that will be looking at a fixed contract price for this out to 2021.

Pat Gallagher (Donegal, Fianna Fail)
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We have taken four minutes-----

Joan Burton (Dublin West, Labour)
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Very briefly-----

Pat Gallagher (Donegal, Fianna Fail)
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We are moving on to the next group of questions.

Joan Burton (Dublin West, Labour)
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The Taoiseach must be aware that-----

Pat Gallagher (Donegal, Fianna Fail)
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Members got four minutes extra.

Joan Burton (Dublin West, Labour)
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-----in terms of the construction contracts-----

Pat Gallagher (Donegal, Fianna Fail)
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We are out of time.

Joan Burton (Dublin West, Labour)
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-----variations and arbitration are resulting in post-build cost increases of up to 20%.