Dáil debates

Tuesday, 15 October 2019

Health and Childcare Support (Miscellaneous Provisions) Bill 2019 [Seanad]: Second Stage

 

7:40 pm

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I move: "That the Bill be now read a Second Time."

I welcome the opportunity to introduce this Bill to the House. I am very grateful to Members of both Houses for their speedy consideration of this legislation, which is very much part of the ongoing Brexit preparedness work of this Government. I acknowledge the constructive engagement of Sinn Féin and other parties in Northern Ireland on the need for this legislation. Members will be aware that we passed the Withdrawal of the United Kingdom from the European Union (Consequential Provisions) Bill 2019, also known as the Brexit omnibus Bill, in this House in April. The purpose of that Bill, from a health perspective, was to deal with north, south, east and west reciprocal healthcare arrangements, but the Bill before us this evening goes above and beyond that. This legislation represents the Government fulfilling its obligations under the Good Friday Agreement and adhering not just to the letter but to the spirit of that agreement in making sure that people from the North, when they holiday in the EU, outside of the Republic of Ireland, can access healthcare in emergency situations. We are talking about situations where, for example, somebody goes to Spain on holiday and gets ill suddenly. The Bill also contains provisions relating to British citizens accessing our childcare scheme.

This Bill is being introduced on my behalf, as Minister for Health, and on behalf of my colleague the Minister for Children and Youth Affairs, as it contains two sets of legislative provisions. The health related aspect concerns the provision of similar benefits to those available under European health insurance card, EHIC, to eligible residents of Northern Ireland in the case of a no-deal Brexit. The Bill also includes amendments to the Childcare Support Act 2018 to provide for British citizens to have access to the forthcoming national childcare scheme on the same basis as Irish citizens.

This legislation has been identified as a clear priority in the context of contingency planning for a no-deal Brexit. As I said, I acknowledge and appreciate the co-operation of colleagues in this House who have facilitated the Bill for debate as a matter of priority. The tight timeframe involved has, unfortunately, been necessary due to the pressing urgency for the legislation to be enacted before the end of the month, given that the Government continues to plan for a no-deal Brexit while obviously hoping for a better outcome. In the context of planning for a possible no-deal Brexit, ensuring that the citizenship and identity provisions of the Good Friday Agreement are respected and upheld in all relevant policy areas is a very important issue upon which the Government is very engaged. The Government continues to work with the UK to reinforce the message that the rights and entitlements of all those living in Northern Ireland are of fundamental importance and must be protected. We are actively engaged in ensuring that people in Northern Ireland can continue to enjoy access to important EU rights, opportunities and benefits into the future, including the benefits of EHIC.

The operation of the EHIC scheme requires that the state that issues the card, in this case Ireland, meets the cost of any services accessed by the holder in another EU or EEA jurisdiction. EU citizens can then visit another member state and, if required, avail of necessary public healthcare during a temporary visit there. Therefore, the objective of this legislation is to ensure that if the UK leaves the EU without a withdrawal agreement, eligible residents in Northern Ireland will not be out of pocket if necessary health expenses are incurred while on a temporary stay in another EU or EEA member state or in Switzerland.

Under the Good Friday Agreement, all the people of Northern Ireland are recognised as having the birthright to identify themselves and be accepted as Irish or British, or both, as they may so choose, and accordingly the right to hold both Irish and British citizenship. In view of the various adverse effects of a no-deal Brexit outcome on EU citizens resident in Northern Ireland, among which is the loss of access to the benefits of the EHIC scheme when travelling to other member states, and recalling the important role the EU plays in supporting the Good Friday Agreement, the Government is putting in place this measure in an effort to mitigate this loss to EU citizens, which includes Irish as well as British citizens. The scheme will be based as far as possible on the current EHIC rules. The applicant must not travel for the purpose of receiving planned healthcare, for example, and any co-payments that apply to residents of the country being visited will not be reimbursable.

Under existing arrangements, EU citizens travelling to another member state who present an EHIC can generally access healthcare at a significantly reduced or no cost basis, which is of significant benefit for these patients. Therefore, the immediate priority now for this House, given the limited timeframe to the end of October and the absolute imperative to have a scheme in place for 1 November 2019, is to devise and implement an approach that ensures, in the event of a no-deal scenario occurring, that eligible residents of Northern Ireland can have access to arrangements that allow them to be reimbursed for the cost of healthcare that may become necessary while on a temporary stay in an EU or EEA member state.

Under the scheme, patients will pay upfront at the point of delivery for their treatment and claim reimbursement directly from the HSE on their return home. My Department has requested the HSE to design and build the ICT and administrative system and this is well under way. In summary, the operational aspects underpinning the direct reimbursement scheme will include an online application portal, with the aim of providing a user-friendly, single-step reimbursement application process for eligible residents in Northern Ireland.

As I stated in the Seanad, this is not a perfect model but it is, after significant engagement with the Office of the Attorney General, the Department of Foreign Affairs and Trade and the European Commission, the best model we can put in place to give access to residents of Northern Ireland after 31 October in the case of a no-deal Brexit which will be as equivalent as possible to that available under the EHIC scheme.

Part 3 proposes to amend the Childcare Support Act 2018 to make provision for British citizens to access the national childcare scheme, a scheme of financial support for parents towards the cost of quality childcare, on the same basis as Irish citizens. Once introduced, it will replace existing targeted childcare schemes with a single, streamlined and user-friendly scheme providing both universal and targeted childcare subsidies. An issue could arise for British citizens living in Northern Ireland who wish to access the scheme and register their children with childcare service providers in the State, and also for British citizens moving to the State to live. In the event of an orderly withdrawal of the UK from the EU, British citizens will be treated as nationals of EU member states for the period of transition. However, in the event of no deal or in the longer term, the policy approach reflected in the Bill, consistent with the principles and intent of the common travel area, is to make provision for British citizens to access the national childcare scheme in the State on the same basis as Irish citizens. The amendments in Part 3 put beyond doubt that British citizens will be eligible to apply for the national childcare scheme in the event of a no-deal Brexit. As such, it offers assurance to British citizens living in Northern Ireland who wish to access the scheme and avail of childcare services in the State, as well as to British citizens moving to Ireland to live.

I will now outline the various provisions of the Bill. In Part 1, section 1 provides the Short Title of the Bill and provides for the commencement of the various Parts of the Bill.

Section 2 is a standard provision concerning the paying of expenses relating to the administration of the Bill.

In Part 2, section 3 sets out the definitions required for Part 2 of the Bill.

Section 4 makes provision for the implementation of a scheme for the reimbursement of expenses incurred by eligible persons resident in Northern Ireland in respect of necessary medical treatment.

Section 5 provides that the Minister may, with the consent of the Minister for Finance, make regulations to provide for administrative arrangements to give full effect to the provisions of Part 2. It also outlines the principles and policies to which the Minister shall have regard when drafting the regulations.

Section 6 provides that the HSE, for the purposes of Part 2 of the Bill, may enter into arrangements with competent institutions in other member states.

Section 7 provides that the HSE may have regard to the decisions of the administrative commission for the co-ordination of social security systems regarding the operation and administration of the European health insurance card scheme as operated under EU Regulation 883/2004.

Section 8 requires the HSE to carry out a review of the operation of the Act no later than two years after its commencement and the Minister must lay that review before the Oireachtas no later than one month after the report is received.

In Part 3, section 9 provides for the definition of "Principal Act" for the purposes of Part 3 of the Bill.

Section 10 provides for an amendment to section 7 of the Childcare Support Act 2018 to make explicit reference to the eligibility of a British citizen to apply for financial support under the Act.

Section 11 is a consequential amendment to section 15 of the Childcare Support Act 2018 to provide that payment will not be made where the person does not satisfy the eligibility criteria in section 7 of the 2018 Act.

Statutory regulations will be required in respect of Part 2 in order to define as necessary the administrative arrangements for the direct reimbursement scheme. Officials from my Department are progressing the drafting of these regulations in conjunction with the Office of the Attorney General.

We have identified on a cross-party basis in both Houses of the Oireachtas this area as a clear priority and part of our contingency planning. By looking to the rights of residents of Northern Ireland in accessing healthcare in EU member states other than Ireland, it goes above and beyond the aim of the Withdrawal of the United Kingdom from the European Union (Consequential Provisions) Act to simply ensure reciprocal rights continued North, South, east and west. I know from speaking to communities in the North that the Bill will be warmly welcomed there. I acknowledge that it is not a perfect fit. It is not what we envisaged when we endeavoured to look at the issue of European health insurance cards but, following significant engagement by officials across a range of Departments and with the Commission, it is a positive step forward in what I hope will be a temporary arrangement or will not occur. As we work towards being prepared for a no-deal Brexit while continuing to do all we can to avoid it, it is important that we pass this legislation.

7:50 pm

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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The Bill provides that Irish, British and EU citizens living in Northern Ireland will retain full access to a European health insurance card. Fianna Fáil wants to see full access to the entire European Union and its schemes and programmes retained for Northern Ireland and, as such, will support the Bill. We also want these rights to be reciprocated. It is imperative that people born in the Republic retain full access to public services in the UK, including healthcare, on the same basis as currently pertains. That is of great importance for the approximately 430,000 people living in the UK who were born in the Republic, but it must also apply to those visiting Northern Ireland or elsewhere in Britain. Of course, the latter group is the target of the Bill and the European health insurance card.

Although Fianna Fáil supports the Bill, it would be remiss of me not to speak to the healthcare service in the Republic to which the Bill would provide access for residents of Northern Ireland. The European health insurance card caters for people on temporary visits. Its purpose is to enable people visiting a country who become ill to access healthcare services. The main service that would be accessed by people from Northern Ireland visiting the Republic would be emergency departments. What do such prospective patients see as they look south of the Border? They see 70 year olds, 80 year olds and 90 year olds waiting on chairs or trolleys for days. They see levels of overcrowding not experienced in Northern Ireland or Britain and that have never been seen before in the South. They see understaffing, with doctors, nurses, allied health professionals and other staff under extraordinary levels of pressure and experiencing fatigue and burnout.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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I am loath to interrupt any Deputy but it would take a very broad interpretation of what is allowable under Second Stage debate of the Bill to cover the area into which the Deputy is straying.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I will be guided by the Ceann Comhairle. My logic is that the Bill expressly seeks to give access to EU healthcare to residents of Northern Ireland.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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Excluding the Republic of Ireland.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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In most cases, that means access to emergency services-----

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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Not in the Republic of Ireland.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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-----and, as such, I am speaking to the services to which the Bill would provide access. I will be guided by the Ceann Comhairle.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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The Minister stated it does not relate to services in the Republic.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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Under the Withdrawal of the United Kingdom from the European Union (Consequential Provisions) Act, residents of Northern Ireland already have access to care. We passed that legislation in April. This Bill-----

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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Where will the Minister put them?

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I am answering a question asked by the Ceann Comhairle.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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The queues in hospitals are out the doors.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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The Bill relates to health services in EU countries other than the Republic of Ireland.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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My apologies for interrupting Deputy Donnelly. He may continue.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I will be guided by the Ceann Comhairle. How bad is the understaffing? I refer to Tallaght Hospital which serves the constituency the Minister and I represent, as well as County Kildare and a large swathe of County Dublin. An equivalent hospital in the NHS or in Northern Ireland would have approximately 16 consultants in emergency medicine. Tallaght Hospital has four such posts, one quarter of the number that would be enjoyed in Northern Ireland. Of those four posts, two are currently being filled by locums. Tallaght Hospital, which serves a significant swathe of Wicklow, Kildare and Dublin, has two full-time consultants in emergency medicine in post. On patients waiting for treatment, all Deputies are aware of the 70-year-old woman who had to wait four and a half days on a trolley in University Hospital Limerick. The reality is that the solutions are right in front of us. We can hire more consultants in emergency medicine. That would mean reversing the inequality in pay for new entrant consultants, but no provision was made for that in the budget.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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The Deputy did not seek such provision.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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It would mean opening diagnostic suites longer, for which provision was not made. It would mean sanctioning posts for nurses in emergency care that have already been agreed as safe staffing levels and it would mean increasing homecare packages linked to discharge from hospitals, which doctors have told me would free up beds in hospitals and allow people to be transferred from emergency care. We want residents of Northern Ireland to have access to all services.

We also want those services at a minimum to be comparable to what they already have in the North. Ideally, we want them to be much better. Obviously, we will support this Bill. We will see it put through tonight. We would very much like to see the attention, focus, investment and care provided by this Government for the services that would be accessed under the Bill.

8:00 pm

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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Nothing would give me more pleasure than to spend all evening debating what Fianna Fáil failed to get from its budget negotiations, but that is not what we are here to discuss. I want to be as constructive as I can in the few words I have to say on this matter. As the Minister will be aware, I am proud to speak as a member of an all-island, 32-county party. We have supported the Government's position on Brexit and related matters. At every opportunity, we have given credit where it has been due. For some time, Sinn Féin has called for a solution to be achieved between the Irish Government and the EU on the availability of the EHIC for people in the North. We have been pushing for this continuously. In fairness, this Bill is proof that the Government has been listening. While it does not go as far as we would like, we recognise it as a step.

We welcomed the Government's announcement that it would be issuing EHICs to people in the North. This decision was very much welcomed by people in the North, who are at the business end of this matter. When the announcement about the EHICs was made, people across the North contacted Sinn Féin representatives across the Six Counties to get more details. This is one of the benefits of Sinn Féin's status as a genuinely 32-county party. In July of this year, the Government published a contingency action plan update, which gave the people of the North an express commitment that they would have access to the EHIC. This was written confirmation of what had already been committed to by many Ministers in the previous year. As the details became clear last Monday morning, like many others I was disappointed to learn that the Government had decided to proceed with a reimbursement scheme rather than an actual extension of the EHIC. The Committee Stage amendments I have proposed would seek to rectify this. Our disappointment was compounded by our knowledge that the Government had committed over recent weeks and months to extend the EHIC to people post Brexit.

We cannot fail to notice the ticking clock on RTÉ as Brexit approaches. We are all very focused on when this legislation may be needed. Of course we hope it will not be required. We need to be prepared. Last week, the Minister told the Seanad:

The initial point we would all have liked to arrive at was a point where one could effectively replicate the EHIC card. For a variety of reasons, including extensive engagement with many different stakeholders, legal advice, the European Commission and, most crucially, the very short timeframe between now and a potential no-deal Brexit on 31 October, we took the decision to go with this version [rather than the extension of an actual EHIC] because we felt it was most important to have a workable scheme in place within that timeframe.

It is hard to disagree with that logic. I ask the Minister to outline the nature of the legal advice he has received. What has the Commission said to entail the replacement of a like-for-like swap of EHICs by a new system that is underwritten by the State? It is convenient to use Brexit as an excuse for everything. Brexit has been going on for a while. I appreciate that time is tight now, but time has not been tight for the past few years, when we had an opportunity to debate this matter. Given that this has gone on for a while, it is a bit of a stretch to say that there is a tight timeframe. We know there is pressure on us with regard to Brexit. We have worked with the Government every step of the way to pass legislation to protect the citizens on this island. It appears to me that the tight timeframe is of the Government's own making.

When the review of this legislation has been completed, I ask the Government to have a longer look at it, rather than being surprised when it runs out of time. The benefits of the EHIC, as opposed to a reimbursement scheme, should be examined. The card is a good scheme. People know how beneficial it is. It allows someone who is on a holiday or a short-term stay to access healthcare in another EU or EEA country without charge. Most people who are travelling will say that having an EHIC gives them great peace of mind. They know that if they need a doctor or if they have an emergency, their EHIC will be there to cover them. The loss of this very important card has been a very serious worry for people in the North since the Brexit vote. We can imagine how reassuring it was for them to get the commitment I have mentioned. The change of direction that involves establishing a reimbursement scheme instead of giving EHICs to people in the North is disappointing. I hope the Minister will explain this evening why they did not get what they were initially promised. This situation is creating practical problems for people who might not be able to pay medical bills in the first instance. It is simply a fact that there are people who might not have the means to pay such bills. They could be left waiting. They are very worried.

It is regrettable that the Government has not fully kept its word on this matter. With that in mind, I have tabled amendments to rectify the problem. My proposals would save the State the expense of a cumbersome reimbursement scheme, the operation of which will be more expensive than a like-for-like swap.

I have submitted two other amendments that pertain to the Childcare Support Act 2018. This Bill provides for British citizens to be able to access the national childcare scheme on the same basis as Irish citizens. This subject is in the news at the moment. It is a very current subject. I hope the Minister will be able to tell me whether the insertion of the phrase "British citizen" immediately presupposes that Irish citizens in the North are British citizens to be assessed in that manner after Brexit. Perhaps the Minister will use his time at the end of Second Stage to explain that. I believe the Bill could differentiate between British citizens, Irish citizens ordinarily resident in the North and British citizens ordinarily resident in the North. The Constitution tells us, "It is the entitlement and birthright of every person born in the island of Ireland .... to be part of the Irish Nation", and to identify as Irish. In light of the recent DeSouza judgment, it would be very helpful if this could be clarified on behalf of the Government. The authorities across the water are trying to deny that Irish people in the North are Irish. For the avoidance of any doubt, they are as Irish as me or the Minister. It is nonsense to suggest otherwise. We certainly will not stand for it. Neither the Minister and the Government should stand for it.

I will conclude by calling again for some clarity. I repeat that we should schedule some time for a debate on what Fianna Fáil failed to get in the budget negotiations. I would very much enjoy such a debate. I would play my part in it. However, we are here to discuss the Health and Childcare Support (Miscellaneous Provisions) Bill 2019.

Photo of Bríd SmithBríd Smith (Dublin South Central, People Before Profit Alliance)
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I support Deputy O'Reilly's important proposals. The Minister has told the House that, "Under the Good Friday Agreement, all the people of Northern Ireland are recognised as having the birthright to identify themselves and be accepted as Irish or British, or both, as they may so choose". Accordingly, the right to hold both Irish and British citizenship extends to them. Given the currency of this matter, it is quite disgraceful that the Taoiseach spoke about it in such a dismissive tone this afternoon. The DeSouza judgment flies in the face of every piece of legislation of this nature that we try to put through the House. Regardless of whether Brexit is accompanied by a deal, we are in big trouble if we do not have an understanding that the Good Friday Agreement remains intact and all of its provisions apply to the people of Northern Ireland almost as if they were sacred. I do not think the people of this country appreciated the sarcastic and dismissive tone that was used by the Taoiseach this afternoon when this issue was raised on Leaders' Questions. The good news is that Ms DeSouza has announced in the last few hours that she intends to continue her legal battle. Rather than criticising people for making demands or insisting that this issue be dealt with, the Government and the Minister for Health should welcome Ms DeSouza's decision. If it does nothing else, it will back up the Government's attempt to legislate for the equal rights of Irish citizens in Northern Ireland and beyond.

8:10 pm

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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I am pleased to be able to speak on the Health and Childcare Support (Miscellaneous Provisions) Bill. I acknowledge the excellent briefing prepared by Ms Emily Heery and the Oireachtas Library and Research Service.

The Bill seeks to maintain the provision of certain health benefits, including the European health insurance card, EHIC, to eligible residents of Northern Ireland and to make provision for British citizens to access the affordable childcare scheme on the same basis as Irish citizens in the event of there being no agreement between the European Union and United Kingdom on the withdrawal of the UK from the EU. We are all weary and are holding our breath and a cross-party alliance has supported the Government on the issue in an effort to salvage some vestiges of sanity from this decision. Things have gone on and on without any clear timelines or deadlines being met. There has been one extension after another. It is hugely damaging to the entire economy of Ireland. Obviously, we need legislation like this and the omnibus Bill. I thank the Minister for his briefings.

We have issues around our hospital services. Deputies Michael Collins and Danny Healy-Rae have come into the Chamber. Deputy Healy-Rae sends bus loads of people to the North to get cataracts, knees and everything else addressed. Many of them were members of Fine Gael long before the Minister was in the party. Maybe they will be there after he is in it too. He is not that long in it. It was not too long ago that he was in another party in Wicklow. I know a small bit about Wicklow. Deputy Donnelly has gone around the House a few times too.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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Deputy McGrath has changed a few times.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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No, never. Once bitten, twice shy. I was in the party all of my life since 2011.

Photo of Danny Healy-RaeDanny Healy-Rae (Kerry, Independent)
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They left us, we did not leave them.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I forgot about Deputy Healy-Rae.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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As I understand it, reimbursement of the necessary medical expenses to eligible residents of Northern Ireland is an exceptional provision which is being proposed by the Government in the spirit of the Good Friday Agreement. I welcome that. I never mention the agreement without mentioning a former Deputy, Minister of State and Senator, Professor Martin Mansergh, as well as Father Alec Reid, two Tipperary men who worked hard with former Taoisigh Bertie Ahern and Albert Reynolds. Father Reid, Martin McGuinness and many others have gone to their eternal reward. It was a milestone agreement and we will do anything we can do to support it. The Leas-Cheann Comhairle knows more about it than I do as he is from a Border county which is one of the nine counties of Ulster. He understands the situation.

It is important that we maintain continuity where possible. The Bill seeks to achieve that. I am worried about some of the legislation because so much of it is going through the House very quickly. These Bills are being rushed; time is not on our side. Legal scrutiny and everything else is sparse. We need to be cautious.

Irrespective of that, I welcome the provision on the eligibility of certain British citizens to apply for financial support under the affordable childcare scheme proposed as part of the Government's commitment to maintain the common travel area, CTA, and its associated rights and privileges. The CTA is very important and borders and customs are issues, but the problem when it comes to Cavan or Letterkenny general hospitals is where we are going to put people. We cannot look after our own. I understand 570 people are on trolleys today. The issue has become sanitised. As Professor Paul O'Regan said, trolleys are fine but because of where they are placed there is a lack of services around them. There are no electrical points for blood transfusions and so on. South Tipperary General Hospital often does not have blankets, pillows or sheets for people on trolleys. There is no proper access to any services.

I have said before and will say again now that the Minister, the head of the HSE and other top people should be brought to The Hague and charged with the crime of sleep deprivation. They are perpetrating war on unfortunate people, from 16 year olds up to people who are 100 years of age. A person aged 103 was on a trolley recently. I honestly think it is a pity. While we welcome the Bill, it is bizarre that we will pile more on top of more while we cannot provide services. I welcome the €2 million provided for autism, which I read about on a flyer yesterday. Any amount of money to deal with autism is welcome-----

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I thought we would announce it before Deputy McGrath sent me to The Hague.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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I will not send the Minister to The Hague.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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It is a terrible allegation.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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The Deputy cannot accuse the Minister of war crimes. It is not the type of language-----

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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I am just saying that if it were wartime, they would be charged with war crimes. There is no war, thank God.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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The Deputy was not being hypothetical.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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What?

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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I do not think the Deputy can charge the Minister with a war crime.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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I am not charging him. I do not have the power to charge him, but if I had the power, I would.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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That is a different interpretation.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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I am making the point that in a war situation the Government or the Administration would be charged, because sleep deprivation is part and parcel of every struggle and war that ever went on. All kinds of things are done to keep people awake. People are lying beside vending machines in hospitals and traffic is passing by. People are all over the place and there is no room to pass by. The hospital in Tipperary is old. CUH and hospitals in Dublin were built a reasonably short time ago, in the past 40 or 50 years. They have wide corridors, unlike the old type of corridors in the hospital in Tipperary where if a person is attending to someone on a trolley, nobody can pass with another trolley or anything else.

As we know, the CTA enables Irish and British citizens to access a range of similar rights on a reciprocal basis, including access to healthcare and education in the other country. It is vital that we do everything we can to sustain that arrangement. I will not oppose the Bill for that reason. As I said, I have major issues. Irish and British citizens can access a range of similar rights. There are issues in the National Health Service, NHS, in Great Britain, but nothing would surpass what we have in terms of the sheer mismanagement and bungling. Front-line staff in all hospitals, including those in regional hospitals, work tirelessly and painstakingly but they cannot cope. They are leaving because of stress. When people in Tipperary have a psychotic episode they have to go into the mad accident and emergency department - I use the term "mad" because of the lack of organisation and the chronic waiting times - and wait up to 20 hours to be seen. We have begged and pleaded with the powers that be to provide a room for people who might be seen in triage. People can be sent to Kilkenny because we no longer have a mental health facility in Tipperary. Those living in north Tipperary have to go to Ennis. We are pleading with the Minister to deal with this issue.

I support the Bill and will co-operate with its passage.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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Deputy Healy-Rae only has one minute.

Photo of Danny Healy-RaeDanny Healy-Rae (Kerry, Independent)
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We have ten minutes.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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Deputy McGrath was sharing ten minutes. The Deputy will have less time now.

Photo of Danny Healy-RaeDanny Healy-Rae (Kerry, Independent)
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In the short time available, I hope that whatever agreement happens our health service does not get any worse. It could not be any worse. We are taking children to have their tonsils and eyes seen in the North. We are lucky to be able to do that. I had a very sad experience recently dealing with a nine year old child from another country who moved to Killarney.

I had to take that nine year old child up to Belfast to get his eyes seen to. His fingers were around his eyes when he tried to read his copybooks during his lessons.

I do not know what happened to my time. I hope that things do not disimprove because they could not be any worse. It is dreadful to think-----

8:20 pm

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
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It is an internal matter among the Deputies. I will give Deputy Michael Collins one minute only.

Photo of Michael CollinsMichael Collins (Cork South West, Independent)
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With Brexit approaching, it will, no doubt, have important consequences for Irish people who must travel to Northern Ireland with their children for important health procedures because waiting lists in the Republic of Ireland are too long. It is vital that the Government navigates its way through uncertain times with our heads well screwed on so that important agreements are held in place and continue well into the future. It is important that we work together and listen to the concerns of the people.

We need to address the extremely long waiting periods for assessment on our own doorstep faced by children with autism and Asperger's syndrome. The Disability Act 2005 provides that children be assessed within short timeframes so that tailored treatment can be identified, but the HSE has consistently failed to comply with this, forcing many to take the private route. People who are unable to take this option must join a waiting list of 18 months and upwards. Once a child is finally assessed, the struggle to find a school place begins. I heard that around 100 parents in Cork attended an open evening last week in the hope of securing a place for a special needs child only to be told that there was one place available for next September. This is not acceptable.

Looking at the simple grommets procedure, children are waiting for years for an appointment during which time they might develop speech delay, which in turn means that they will need speech therapy. This is a classic example of how the Government keeps kicking the can down the road. Why can it not see that if we treat the condition when it arises, it will save time and money in the long run? Parents see this and are taking their children to private hospitals in Northern Ireland. People are travelling to Northern Ireland for a simple tonsillectomy because children are suffering in pain. Why can this not be done in a reasonable time in Bantry General Hospital or in Cork?

Photo of Katherine ZapponeKatherine Zappone (Dublin South West, Independent)
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I welcome the opportunity to conclude, particularly since the Minister for Health introduced the Bill on his and my own behalf. I will discuss the aspect of this Bill relating to the national childcare scheme along with another issue raised during Second Stage. I will launch the national childcare scheme in a few weeks. It is our pathway to accessible, affordable and quality childcare in Ireland. It is a scheme of financial support for parents towards the cost of quality childcare. Once introduced, it will replace the existing targeted childcare schemes with a single, streamlined and user-friendly scheme providing both universal and income related subsidies. By tangibly reducing the cost of quality childcare, the scheme aims to improve children's outcomes, support employment and lifelong learning, reduce child poverty and support gender equality. The launch of the national childcare scheme will be a landmark. It creates the first ever statutory entitlement to childcare support in the State.

Through this Bill, we will copper-fasten the statutory entitlements for British citizens. We will ensure they can access the scheme on the same basis as Irish citizens and that the principles and intent of the common travel area are reflected in the legislative framework for the national childcare scheme. Part 3 of this Bill proposes to amend the Childcare Support Act 2018 to make provision for British citizens to access the national childcare scheme on the same basis as Irish citizens.

To address directly something raised by Deputy O'Reilly, the term "British citizen" does not presuppose that all those in Northern Ireland are British citizens. Irish citizens are already covered by reference to EU citizens in the Act. This covers both Irish citizens in the State and Northern Ireland. In drafting the Bill, the Office of the Parliamentary Counsel was satisfied on this point. In the event of an orderly withdrawal of the UK from the EU, British citizens will be treated as nationals of EU member states for the period of transition. However, in the event of no deal or in the longer term, the policy approach reflected in this Bill, consistent with the principles and intent of the common travel area, is to make provision for British citizens to access the national childcare scheme in the State on the same basis as Irish citizens. The amendments in Part 3 put beyond doubt that British citizens will be eligible to apply for the national childcare scheme in the event of a no-deal Brexit. As such, it offers assurance to British citizens living in Northern Ireland who wish to access the scheme and avail of childcare services in the State as well as British citizens moving to Ireland to live.

I am aware that Deputy O'Reilly has tabled amendments to Part 3 of the Bill that propose to add references in sections 7 and 15 of the Childcare Support Act 2018 to include Irish citizens who are ordinarily resident in Northern Ireland and British citizens who are ordinarily resident in Northern Ireland. However, section 7 of the Childcare Support Act sets out the persons who are eligible to apply for financial support under the national childcare scheme. Section 7(1)(b)(iv) provides that persons who are nationals of a member state of the European Union are eligible to apply for financial support under the scheme. Irish citizens ordinarily resident in Northern Ireland are, therefore, already covered in section 7. There is no need to refer specifically to Irish citizens ordinarily resident in Northern Ireland as they will continue to be nationals of an EU member state after Brexit.

British citizens who are ordinarily resident in Northern Ireland are captured by the amendment proposed at section 10 of the Bill. This is because British citizens regardless of their ordinary residence will be eligible to apply for the scheme. There is, therefore, no need to refer specifically in section 7 to British citizens ordinarily resident in Northern Ireland.

Similarly, the consequential amendments proposed to section 15 of the Childcare Support Act 2018 are unnecessary as Irish citizens ordinarily resident in Northern Ireland are already captured under section 7(1)(b)(iv), while British citizens ordinarily resident in Northern Ireland will be captured by the amendment proposed at section 10 of the Bill. As such, the amendments proposed by Deputy O'Reilly are unnecessary, but I thank her for the opportunity to clarify these important matters and I hope this explanation provides reassurance with regard to the eligibility of persons living in Northern Ireland.

The Bill demonstrates the Government's continued commitment to contingency planning for a no-deal Brexit and to ensuring that the provisions of the Good Friday Agreement and the principles and intent of the common travel area are respected and upheld in all relevant policy areas. I acknowledge and appreciate the co-operation of colleagues in the House, who facilitated the Bill for debate as a matter of priority. The tight timeframe has been necessary, unfortunately, due to the pressing need for the legislation to be enacted by the end of the month.

Question put and agreed to.