Gerry Adams (Louth, Sinn Fein)
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5. To ask the Taoiseach when the Cabinet committee on health last met; and when it is scheduled to meet again. [16551/17]

Micheál Martin (Cork South Central, Fianna Fail)
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6. To ask the Taoiseach when the Cabinet committee on health last met; and when its next meeting is due to be held. [17831/17]

Brendan Howlin (Wexford, Labour)
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7. To ask the Taoiseach when the Cabinet committee on health last met; and when it next intends to meet. [17853/17]

Enda Kenny (Mayo, Fine Gael)
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I propose to take Questions Nos. 5, 6 and 7 together.

The Cabinet committee on health last met on 21 March. It will meet again on 27 April. That response is inside the time limit.

John Brady (Wicklow, Sinn Fein)
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I welcome the agreement between Vertex and the HSE. We got positive news yesterday on the provision of Orkambi and Kalydeco for sufferers of cystic fibrosis, CF. It comes during the national awareness week for cystic fibrosis. I commend Cystic Fibrosis Ireland, all the families and their supporters for their persistence in campaigning for this issue over a considerable period. However, the crisis around CF therapies is also evidence of the wider crisis in our health service. Two weeks ago, Dr. Tom Keane, former director of the State's cancer control programme, said that if any other country had the kind of problems found in the Irish health service, the Government would not survive. He described the health service as being close to total systems failure and called for the delivery of health care to change before there is what he described as a profoundly negative impact on people dependent on the public system.

The Towards 2026 report argues for greater accountability, clarity on funding, better leadership and stronger political support. The Government has failed dismally on all of these fronts. This week, we learned that there are 82 unfilled posts across community mental health services that cater for children and adolescents with severe mental health disorders, including suicidal youngsters. This is a damning indictment of the Government. What measures will it take to address this matter urgently?

Micheál Martin (Cork South Central, Fianna Fail)
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I also pay tribute to Cystic Fibrosis Ireland on an extraordinary and very fair campaign by Philip Watt and his team. I also pay particular tribute to Jillian McNulty, who very bravely led the campaign for Orkambi. There are lessons to be learned. I wonder if the Cabinet committee has considered the broader question of how we deal with orphan drugs. That is the term given to drugs used for rare diseases. In respect of conditions and diseases that are particular to the Irish DNA and are more prevalent here than in other areas, there is a need for a more effective approach from the Government to the approval of drugs.

In the earlier phase of this campaign, there was no engagement going on if the truth be told. That is what worried me more than anything. There was then an attempt to undermine the quality of Orkambi as a drug.

I raised the matter with the Taoiseach several times on Leaders' Questions. Despite all the leaks to the various newspapers, it took six weeks to two months to get acknowledgement that Orkambi is a valid game-changer in terms of its impact on people with cystic fibrosis of a particular mutation. That has concerned me somewhat and it speaks to a lack of an overall policy.

I am unsure whether Fine Gael has a policy on health anymore. Compulsory health insurance was dropped. The damage of the Reilly and Varadkar years has been left in place. One of the core issues that emerged from that period was the degree to which there was direct interference with transparent and honest service planning within the HSE. Repeatedly, Ministers have required the HSE to promise a level of service for which the required funding has not been provided. Will the Taoiseach provide an assurance that no member of Government has interfered with the wording of this year's service plan to cover up a mismatch between promises and funding? Can the Taoiseach explain why we have had repeated failure to implement funding for mental health services? The Government's existence rests on having promised this funding. The Government has not delivered in terms of mental health funding as promised this year.

Brendan Howlin (Wexford, Labour)
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I commend the Government and all those involved, especially Cystic Fibrosis Ireland, on their efforts to reach a conclusion on the Orkambi issue. I hope it will be a pathfinder for similar issues as they arise, especially for discrete groups of people who suffer terribly despite the fact that breakthrough medicines are available.

Will the Taoiseach address the status of a Government commitment, that is, free GP care for those under 12 years? I am sure this matter was discussed at the Cabinet sub-committee. The Taoiseach will remember that this was announced in October 2015 for budget 2016. It was announced 18 months ago when we were in government together. A total of €10 million was allocated in last year's budget to provide GP visits for children aged between six and 12 years. Where is this provision? When will we see it fully rolled out?

Pat Gallagher (Donegal, Fianna Fail)
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Does Deputy Burton have a short question?

Joan Burton (Dublin West, Labour)
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Before the Christmas recess, I brought to the attention of the Taoiseach the very distressing case of a young child aged nine years who has scoliosis. Not only does she have scoliosis, she also has severe intellectual disabilities. I received some letters from the Taoiseach's office and from the Minister for Health, who spoke to me personally. He reassured me that, at the outside, by now the child would have received the urgently-needed operation. As the Taoiseach can imagine, the child's mother is in touch with the hospital all the time but she and her daughter have simply been told to wait and wait. The operation now seems to have been put back well back into the next couple of months. We were sure it would have been performed by now. I have not raised the matter with the Taoiseach again since then.

I cannot understand a system that keeps a child of nine years with a well-diagnosed condition and exceptional other difficulties and issues waiting. Notwithstanding all the funding that was provided to renew the operating theatre at the hospital in Crumlin during our period in government – a matter on which we all strongly agreed and which we supported – it seems that the hospital is now down to performing one operation per week. That is unbelievable. Will the Taoiseach give us an update on what is happening? Children are in pain and their families are experiencing some level of desperation.

Enda Kenny (Mayo, Fine Gael)
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I cannot give Deputy Burton an answer to her question because I do not have that information, but I will find out for her. We have discussed previously the opening of a theatre which was paid for by the taxpayer for some years but which has not been opened. On the previous occasion on which this was raised, my understanding was that the appropriate and qualified personnel would be there to commence performing operations. Let us find out. I will come back to Deputy Burton on that.

Deputy Micheál Martin raised the question of health policy. It has always been accepted that Orkambi is a game-changer in the sense of improving the quality of life of patients with cystic fibrosis. The problem lay with the price being demanded by the company involved. This is one of the most expensive drugs ever in the history of the State. The pharmacoeconomics group met the company. As Deputies are aware, a change has taken place whereby the group makes a recommendation on whether a given cost is valid. The Minister proceeded to make contact with other Ministers in other countries where similar problems have arisen. In any event, I am pleased the matter has been resolved. It was never a case of not recognising that Orkambi is a valid drug for improving the quality of life for patients. Cost was the issue. The earlier exchange was on looking at the process. This is not confined to Ireland. If this is the first case in Europe of having a portfolio of drugs that provide certainty and stability for patients, then that is probably the way to go. It may well reduce the cost over a five or ten-year period. While Orkambi and Kalydeco will cost a substantial amount of money over ten years, they give that certainty and emotional support for patients who suffer from cystic fibrosis.

I agree with the various speakers that cystic fibrosis patients have an exceptional commitment to dealing with their particular challenges. I am pleased that in recent years we have had public expenditure in cystic fibrosis units at various locations throughout the country. The improvement in the air quality in these centres - the air is changed so many times every hour - adds greatly to their comfort and ability to go to the next day and so on. In that sense I am pleased this matter has been resolved. I hope the Minister for Health will now be able to move on to other drugs companies and discuss portfolios of drugs for particular categories of patients who need them.

Deputy Micheál Martin spoke to me before about the mental health situation. I know he is concerned about it. I will give the Deputy an update from the Minister of State, Deputy McEntee, on where we stand, what money is being spent and on what it is being spent in order that we can see whether we can progress that matter.

Deputy Brady referred to Professor Keane. Obviously, he did his job with the cancer centres of excellence. That was a difficult issue for many hospitals. I disagree with Deputy Brady's suggestion that there is anything like a total systems failure. The vast majority of people who have gone through the public health system have nothing but credit and praise to offer in respect of those who work in the system. In many cases, staff are working under pressure. A total of €14.6 billion has been allocated for 2017 - up €1 billion on last year. We can see how issues can intervene in that in the light of the Orkambi and Kalydeco question.

John Brady (Wicklow, Sinn Fein)
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A total of 60 more people are lying on trollies.

Enda Kenny (Mayo, Fine Gael)
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The problem is to get inside the system in a way that is efficient and realistic for people. That is why we have had pressure in emergency departments. In the context of Wexford General Hospital, for example, the layout of the new emergency department has greatly eased the pressure that used to apply there. That is what we need at many other locations as well and that is part of the plan for the capital expenditure programme. The Minister has visited various hospitals throughout the country. There are particular pressures in some. The filling of posts is another issue. An incentive is being set up by the HSE to bring back nurses and other medical personnel to work in Ireland because we need them.

Deputy Howlin referred to the general practitioner contract. Several measures have gone through, as the Deputy is aware, including the universal GP services for all children under six years and all persons aged 70 years and over.

Brendan Howlin (Wexford, Labour)
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We did that at the time. I am asking about the next stage.

Enda Kenny (Mayo, Fine Gael)
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I know that. The category Deputy Howlin mentioned is being examined with a view to implementing it. We did the asthma cycle of care for children under six years and the diabetes cycle of care for adult patients with type 2 diabetes. Obviously, there needs to be a decisive shift in the health service towards primary care.

Brendan Howlin (Wexford, Labour)
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When will it be provided?

Enda Kenny (Mayo, Fine Gael)
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A number of primary care centres are being built. Many of these close at 5 p.m.

We need to look at the contract with the GPs in terms of the way that service is provided. The development of a new and modernised contract, which has not been done for years, is an issue the Minister is very concerned about and one he is obviously working on. He has stated his wish to have that kind of consultation with the GPs to help to chart a future for primary care services. The process that he set up here-----

Brendan Howlin (Wexford, Labour)
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When will the under 12s get their GP care?

Enda Kenny (Mayo, Fine Gael)
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I do not have a date for that but I will come back to Deputy Howlin on it. The process will include consultation of members of the public, service users, advocacy groups, a range of health professionals and so on. I will advise the Deputy on what the state of progress is.