Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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1. To ask the Taoiseach when the Cabinet committee on health will next meet. [30165/17]

Leo Varadkar (Dublin West, Fine Gael)
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The Cabinet committee on health last met on 30 May. A date for the next meeting has not yet been confirmed. I have said that I intend to reconfigure the Cabinet committees into a smaller number. I expect to do this shortly.

The committee provides a basis for the political oversight of the development and delivery of key health service reforms in line with the commitments in A Programme for a Partnership Government.

The programme'spriority is access to safe and timely care that is provided as close as possible to patients' homes. This will be achieved by making a decisive shift to primary care, guaranteeing the future sustainability of practice in rural and disadvantaged urban areas, creating a healthy Ireland, building capacity for our emergency and acute services, improving waiting times for hospital procedures, reforming the HSE into a more efficient and transparent health service for patients and staff and developing a new funding model for the health services.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I raised this issue with the Taoiseach last week. I am raising it again to make a point about the high cost of medicines in this country. I think the Taoiseach is aware of the case of a lady called Charlotte Connolly from his time as Minister for Health a few years ago. Charlotte suffers from Degos disease, which is extremely rare. She is the only person with it in Ireland at the moment. I spoke to her husband Declan approximately an hour ago. He is in a very precarious position as Charlotte's husband. He wants to see the best for Charlotte, who was diagnosed with this illness three and a half years ago. Somebody who is diagnosed with Degos disease usually has a four-year limitation on his or her lifespan. Declan is extremely worried about his situation.

The drug Charlotte is trying to access is called Soliris, made in Blanchardstown by Alexion, and it costs €400,000 per year, which is extraordinary. There was also a lot of publicity around Orkambi. Does the health committee review the price of drugs in this country? They are exorbitant. When the drugs are made in Ireland, those prices seem to be extortionate.

Leo Varadkar (Dublin West, Fine Gael)
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The Cabinet sub-committee on health, as is the case with all Cabinet sub-committees, has a very wide remit and there is no reason why it could not include in its remit an examination of the cost of medicines. However, one of the reasons some of these medicines cost so much is that they are produced for very rare diseases. There may be only a few dozen or a few hundred patients in the country or in all of Europe and America with a particular disease and the cost of developing medicines for rare diseases, known as orphan drugs, is very high for that reason. Any bespoke preparation of a product or service will cost more than a product for the mass population, say 20,000 or 30,000 people.

One thing that could be done, which would not be possible for a small country such as Ireland but which might be possible on a transcontinental or international level, is to have greater investment by governments in research and development, with governments producing and owning the patent for these medicines.

Micheál Martin (Cork South Central, Fianna Fail)
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I support Deputy Gino Kenny in respect of this case. It is more than just costs, it also involves some engagement with the company on the application of the drug to this particular condition. People should knock heads together to find a solution.

In recent years there has been growing confusion as to what exactly constitutes Government policy on health. Since the enforced departure of Senator James Reilly from the Department and the mothballing of the compulsory insurance scheme, it has not been clear what is the Government's policy on health. During the Fine Gael leadership campaign, the Taoiseach said the implementation of the Oireachtas committee's report would be policy. Can he confirm that this report is now official Government policy? He also said he would take personal charge of, and a personal oversight role in, health policy. Can he outline to the House what he means by that? The Taoiseach's predecessor said the same and resiled fairly quickly from that commitment.

The Cabinet sub-committee on health has had a terrible record in recent years. It cleared the uncosted and abandoned White Paper on compulsory health insurance. It was supposed to be overseeing budget control. How does the Taoiseach intend to change this poor performance? He said he would change how committees would work and clearly the sub-committee on health has not worked. Can he give a commitment that there will be no repeat of the practice of amending the HSE's annual plan to promise the delivery of more services than the budget actually provides for?

Mary Lou McDonald (Dublin Central, Sinn Fein)
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What is the view of the Taoiseach on recent reports that up to nine hospitals have suffered outbreaks of the lethal superbug, carbapenemase-producing enterobacteriaceae, CPE? An unspecified number of deaths have resulted and Tallaght hospital was particularly affected, with wards closed and 700 operations cancelled. The increase in superbugs in hospitals is the result of too few staff, overcrowding and the especially high number of patients on trolleys. In Tallaght, much of the blame is being laid at the door of financial cuts to the cleaning budget. Clearly, short-sighted cuts to hospital budgets and an inadequate response by Government to overcrowding in our emergency departments have created a worsening crisis. Will the Taoiseach instruct the Minister for Health and his Department to provide an urgent report on this situation and to publish an emergency action plan to tackle this crisis?

The Health Service Executive was €31.5 million over budget in the first three months of this year. At the same time, there are continually high numbers of citizens waiting on appointments and on trolleys. According to the Irish Nurses and Midwives Organisation, INMO, last month there were new record levels of overcrowding in our emergency departments when compared with previous years. There were 8,154 admitted patients on trolleys during that period. It is clear that our service is in crisis and remains too small and unable to cope with the demands placed on it. Is the Taoiseach of the view that the HSE can deliver its planned services for the remainder of the year and remain within the €14 billion allocated by Government?

Brendan Howlin (Wexford, Labour)
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I have three brief questions. Where exactly stands Sláintecare? I have been trying to get a clear view from the Department of Health. Is the Sláintecare accepted by Government and has the process of implementation begun? Who is going to drive that implementation? Will it be the Taoiseach, through the cabinet sub-committee, or is there another implementation mechanism?

My second question relates to capital investment and we are currently in the middle of a capital review. How are the health care requirements to be prioritised? Will there be a debate about that? Will it be determined by the Cabinet sub-committee in advance of the Department of Public Expenditure and Reform reaching its conclusions?

My final question is on the outstanding moneys due to consultants under an agreement concluded with a previous Minister for Health, Mary Harney, which will now crystallise into a bill of some €300 million. Where stand the negotiations on that and how will it fit into the budgetary arithmetic?

Joan Burton (Dublin West, Labour)
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I wish to raise the issue of hospices throughout the country, including our own area on the north side of Dublin and in Cork and Donegal, which are section 39 organisations. Their nursing staff, who are highly prized and highly efficient, have to be paid the restoration increases in recognition of the pay cuts they voluntarily took at the time of the financial crisis. The Department of Public Expenditure and Reform and the Taoiseach have been pulling their punches on whether the hospices' budgets will be recompensed in respect of the increases they have to give to these fabulous staff who are caring for our families. The home care services of the hospice movement has expanded in recent times to provide end-of-life care and home care visits to people in long-stay institutions. It has been incredibly successful and is reducing some of the accident and emergency pressure on hospitals. I know the Taoiseach has personal experience of this issue and is sympathetic. We have a mutual interest in our local hospices. Can he address the issue for hospices in general? I know he has been made aware of it.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I spoke about Charlotte Connolly's situation and I ask the Government to intervene. Charlotte is looking for a three-month trial of the drug in question. Other people with the same condition have taken it in the United States and have experienced huge health benefits. Charlotte was diagnosed three and a half years ago. If it was the Taoiseach's loved one in this scenario, he would do absolutely anything to extend his or her life and Charlotte just wants to have a go at life, which she deserves. As somebody who lives out in Blanchardstown, where this drug is made, can the Taoiseach make an exception so that Charlotte Connolly can have the chance she deserves?

Leo Varadkar (Dublin West, Fine Gael)
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The Government policy on health is as detailed on a significant number of pages in the programme for Government. In regard to the Sláintecare report-----

Micheál Martin (Cork South Central, Fianna Fail)
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What about the report of the Committee on the Future of Healthcare?

Leo Varadkar (Dublin West, Fine Gael)
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I am getting to that. There were many questions on this topic and it may take more than 30 seconds to answer all of them. I will start again.

The Government policy on health is as outlined in the programme for Government. That is where Government policies are detailed unless an alternative policy is subsequently produced by the Government. The Sláintecare report was discussed at Cabinet last week and the Minister for Health, Deputy Harris, has undertaken to consider it in full and develop a reasoned response to it on behalf of the Government and decide whether to accept it in full or in part. Several issues need to be teased out, not least that the initial view of the Department of Public Expenditure and Reform is that the costings in the report are not accurate and do not adequately provide------

Micheál Martin (Cork South Central, Fianna Fail)
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Was that not in the Taoiseach's manifesto?

Leo Varadkar (Dublin West, Fine Gael)
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I will get to that issue but I can only answer questions if I am allowed to do so. A number of issues need to be teased out, not least the costings, and also other matters. I did not produce a manifesto; I produced a policy ideas paper, on the front of which it is stated that it is a policy ideas paper. It is not a manifesto, it is an ideas paper-----

Micheál Martin (Cork South Central, Fianna Fail)
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Better to have the exit door.

Leo Varadkar (Dublin West, Fine Gael)
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-----and says specifically in its introductory section that it does not supersede the programme for Government or the confidence and supply agreement made with Fianna Fáil.

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

Brendan Howlin (Wexford, Labour)
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The Taoiseach thinks out loud.

Leo Varadkar (Dublin West, Fine Gael)
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I did not say that I would take personal responsibility for or charge of health; I said that I would take an interest in it and I will do so. Tomorrow I will meet the Minister for Health, Deputy Harris, and the Secretary General of his Department in order that they might give me a better overview of what is happening in the health service and to consider how I can bring the support of the Department of the Taoiseach behind the great effort that is needed to turn our health service around. We have demonstrated in recent years what can be done to turn around the economy and the employment situation and to put our public finances back in order. I would like to be able to use the Department of the Taoiseach to lead in that way and improve our health service considerably. We will never have a perfect health service. No country does. However, Ireland is an outlier in terms of the charges people have to pay and the time they have to wait to access either elective or emergency services. I would like it to become a normal country in the context of such matters. I appreciate that will not be done overnight but will take several years of reform.

I do not have any specific information regarding CPE. Deputy McDonald may wish to raise the issue with the Minister for Health. There are many reasons why hospital-acquired infections or superbugs become more or less prevalent. Notwithstanding the factors mentioned by the Deputy, another superbug, methicillin-resistant staphylococcus aureus, MRSA, is much less prevalent now than it was several years ago. The reasons for any infection being more prevalent in a hospital or community setting are multi-factorial and influenced by many issues. Overcrowding and staffing levels are only two of the many factors that affect the prevalence of any infection in either a hospital or community setting.

I am not party to any negotiations with consultants regarding their legal claim and it would not be normal for a Taoiseach or Cabinet committee to be involved in such.

Brendan Howlin (Wexford, Labour)
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Would the the Taoiseach not be aware of it given the potential cost of €300 million, which would have a significant impact on the budget?

Leo Varadkar (Dublin West, Fine Gael)
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I am aware of estimates in that regard, as is Deputy Howlin because we spoke about the issue when he was Minister for Public Expenditure and Reform. I am aware of the potential cost of the case being decided against the State. However, if one was to add up the potential cost of all legal cases being taken against the State, it would be many billions of euros, not just hundreds of millions.

Brendan Howlin (Wexford, Labour)
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Is the Taoiseach not negotiating a settlement?

Leo Varadkar (Dublin West, Fine Gael)
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Not that I am aware of.

In regard to section 39 organisations, I refer Deputy Burton to the answer I gave to Deputy Micheál Martin on this exact issue during today's Leader's Questions. I reiterate that the Government will take a very dim view of any body that tries to reduce services when it has had its budget increased and that will be-----

Micheál Martin (Cork South Central, Fianna Fail)
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That is a twist of the truth.

Joan Burton (Dublin West, Labour)
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That is not the case.

Micheál Martin (Cork South Central, Fianna Fail)
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That is outrageous. The Taoiseach said the same thing previously. He is wrong on that point.

Joan Burton (Dublin West, Labour)
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He is wrong.

Pat Gallagher (Donegal, Fianna Fail)
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The Taoiseach to conclude.

Micheál Martin (Cork South Central, Fianna Fail)
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He is being disingenuous. Hospices are being bled dry.

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

Joan Burton (Dublin West, Labour)
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They are not suggesting that services be reduced.

Micheál Martin (Cork South Central, Fianna Fail)
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Can the Taoiseach clarify that issue?

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

Leo Varadkar (Dublin West, Fine Gael)
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The Deputy was suggesting that services might be reduced at a time when budgets have increased and obviously we would need to understand that-----

Micheál Martin (Cork South Central, Fianna Fail)
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We have met representatives from the hospices. The Taoiseach should not be disingenuous.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Deputy Micheál Martin did not say that.

Joan Burton (Dublin West, Labour)
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That is not what he said.

Micheál Martin (Cork South Central, Fianna Fail)
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The hospices are not being given any money for the pay increases and they are screwed as a result. That is the reality.

Pat Gallagher (Donegal, Fianna Fail)
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I cannot allow another round of questions. We will move on to questions 2 to 5.

Joan Burton (Dublin West, Labour)
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The staff voluntarily took those pay cuts and deserve pay restoration.

Brendan Howlin (Wexford, Labour)
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Money has been provided to all other public service employees.

Micheál Martin (Cork South Central, Fianna Fail)
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Deputy Howlin is correct. It is unfair.

Joan Burton (Dublin West, Labour)
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The Taoiseach is avoiding the answer.