Mary Lou McDonald (Dublin Central, Sinn Fein)
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Yesterday the sad news broke that Vicky Phelan had passed away. Her two children, Amelia and Darragh have lost their beautiful mother so early in their lives. Our hearts go out to her husband Jim, to her heartbroken parents, Gaby and John, and to Vicky's family and friends who are devastated by her death. The nation mourns with them.

Vicky Phelan was a force of nature. In pursuit of justice she was fearless and relentless. She was unstoppable. If it was not for Vicky's courage, the CervicalCheck scandal may never have been exposed. With inspiring dignity Vicky took on the State that had failed her so badly. It was a battle she should never have had to fight but fight it she did until her very last breath. Vicky endured her illness and she never backed down in campaigning for the women and girls of Ireland. Her legacy will live on. We owe her so much.

Vicky, as has been said, did not want fame or adulation; she wanted purposeful change. The best way to honour Vicky's memory is to complete the work she did. That means bringing the testing of screening samples back to Ireland. Testing continues to be outsourced to labs in the United States at the centre of the CervicalCheck scandal. Currently, 85% of CervicalCheck sample testing is outsourced abroad. The national cervical screening laboratory was due to open in September, yet the women of Ireland are still waiting.

Completing the work also means delivering the long-promised legislation for open disclosure. The Scally review recommended a statutory duty of candour be established to ensure people are told the truth when something goes wrong in their healthcare. Yet, incredibly, the Patient Safety (Notifiable Patient Safety Incidents) Bill published by the Government in 2019 would not cover disclosure of the incidents at the heart of the CervicalCheck scandal. We in Sinn Féin have proposed amendments to rectify this issue but the Minister, Deputy Stephen Donnelly, has for seven months failed to progress the legislation. Again, the women of Ireland have been left waiting. We must also see the reinstatement of the cancer audit review of screening, which was suspended four and a half years ago.

It is the wish of Vicky’s family that these specific issues be raised today because she cared so passionately about this change. Everyone in the Dáil is committed to ensuring that we never again see the failures of the CervicalCheck scandal. We will have to work together to deliver the change that Vicky wanted to see.

Is é an bealach is fearr chun ómós a thabhairt do chuimhne Vicky ná scagthástáil a thabhairt ar ais go hÉirinn agus reachtaíocht a chur i bhfeidhm i gcomhair nochta oscailte. We are all waiting for the national cervical screening laboratory to open. When will this happen? Will the Taoiseach ensure that on its opening, it has the capacity to test all cervical screens conducted in this State? When will the Minister for Health progress the open disclosure legislation? That legislation must be amended to ensure it covers the type of incidents at the centre of the CervicalCheck scandal. The law must provide for open disclosure. Vicky Phelan was very clear. She said:

I want action. I want change. I want accountability.

Let us get this done together for Vicky, for all the women we have lost and for those women who continue to suffer and fight for justice.

Micheál Martin (Cork South Central, Fianna Fail)
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I thank the Deputy for raising the issue and for the manner in which she raised it. I agree wholeheartedly that it is extremely important that the work of Vicky Phelan is reflected in action in terms of legislation, in terms of the framework and architecture of the screening programme itself, insofar as it is located in Ireland, and in terms of the renewal of an audit of the screening programme. It is important to her family in particular that her advocacy continues to change things after her passing and that her legacy will be more effective and respectful treatment for the women who come after her. That is extremely important and is an issue we want to follow through on.

On the CervicalCheck programme, the ultimate goal, supported by Vicky and many involved in the 221+ group, is population-based screening, the continuation of the cervical screening programme and participation by women in that programme. Population-based screening has ensured better survival rates regarding different cancer types.

I was involved in the roll-out of BreastCheck. We did it differently insofar as it was a much slower roll-out from one region of the country to the next and took much longer. The CervicalCheck screening programme has saved thousands of lives but, as we know through the work of Vicky Phelan and her decision to ensure there would be no confidentiality, there were significant flaws within the programme. The Government wants to eliminate and eradicate cervical cancer. That is the objective.

We can achieve this through the HPV vaccination programme and an effective screening programme. The Minister recently announced the Laura Brennan HPV vaccination catch-up programme, which will be implemented by the HSE shortly.

On Dr. Scally's recommendations, I am informed that actions on all 170 recommendations are near completion or have been completed. The Minister for Health has asked Dr. Scally to conduct a final progress review of implementation. The report in that regard is expected to be submitted to the Minister shortly.

The new national cervical screening laboratory at the Coombe, which will provide enhanced capacity to meet the future needs of the national cervical screening programme will be the national base for training, education and research. The building works for the new lab were completed in October. It is expected to become operational by the end of the year. A workforce plan is in place. Recruitment for the new laboratory is an ongoing priority for the HSE, which is working with the faculty of pathology to build the required expertise. I understand that Dr. Cillian De Gascun was recently appointed as interim director of the national cervical screening laboratory. The new laboratory is designed to ultimately become CervicalCheck’s main provider of cervical screening laboratory services. The HSE is working flat out to see if that can be done before the end of the year.

In respect of the legislation, my understanding is that there was agreement among all parties on Committee Stage that on Report Stage an agreed amendment in respect of full disclosure would be brought forward. There have been many different perspectives among health professionals for a long time although many would support the duty of candour and the spirit, idea and principle of candour in the context of full disclosure to patients. I have had discussions with the Minister and he has indicated that, working with the Office of the Attorney General, we will have that amendment prior to the end of the year. Working with all parties in the House, we can bring this to a conclusion.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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I support the Taoiseach's comments regarding the importance of population screening and the importance for women to participate in CervicalCheck. All of us who avail of the service are well aware of its absolute value.

Vicky’s ambition to bringing screening home can be achieved. It was a catastrophic error for the laboratory services not to be available and for screening not to be carried out in this jurisdiction. I want to put that on the record. Can the Taoiseach assure us that when the national laboratory opens - and he says he hopes this will happen by the end of the year - that it will not just be additional capacity but that we work for sufficient capacity that screening in its entirety can happen here in Ireland?

On open disclosure legislation, can we just confirm today that we will get this done by the end of the year, namely, before we rise for Christmas? Can the Dáil agree that we will get this done rather than speculating or giving speculative target deadlines? Can we agree that we will work together for that happening?

I asked the Taoiseach about the cancer audit review and its reinstatement. Will he say something on that matter?

Micheál Martin (Cork South Central, Fianna Fail)
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Work in respect of the national cervical screening laboratory at the Coombe is under way. It will take time before it will have sufficiency to offer full national coverage, although I would point out - and we have to be objective as best as we can - that Dr. Scally did not find, in respect of the particular lab, that there was a higher or lower incidence than elsewhere. Be that as it may, it is desirable that we would build up the expertise and education in Ireland and that, similar to BreastCheck, we would recruit the proper experts and personnel over time and have this as not only a national centre but also ensure that it will have the capacity to cover the entire programme. That is the objective.

I already articulated that there should be an audit because audits inform best practice. They are part of the broader approach to ensuring that the programme is effective and is benchmarked against international peer review and international best practice and standards.

I want the legislation concluded by the end of the year. We will work might and main to make sure that happens.

Róisín Shortall (Dublin North West, Social Democrats)
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Everyone in this House owes a debt of gratitude to Vicky Phelan. While battling terminal cancer, Vicky took a case to the High Court. She won her case and was offered a settlement if it remained confidential, as we know. It would have been easier for her had she acquiesced, but she refused to accept the culture of secrecy that too often accompanies scandals in Irish public life. This was not in her interests but was in the public interest. Vicky was concerned that if she stayed silent, nothing would change and other women would face the same fate as her, namely, to die of a treatable disease because of faults in the screening system. She was not willing to accept that. Crucially, she felt that when things go wrong, patients and their families must be informed. They should expect openness and honesty. If the health service does not recognise a problem, how can it deal with it?

There has been reform of the cervical screening programme because of Vicky Phelan and many other women who became involved in the cervical check issue. However, some of the important changes that Vicky advocated remain outstanding. The Taoiseach has referred to some of them. I want to pursue a number in more detail.

The HSE introduced a national open disclosure policy in 2013, but we all know that open disclosure does not always happen. The purpose of the patient safety Bill is to change this. It is to make the policy of open disclosure mandatory rather than discretionary. Unfortunately, as we have just discussed, the progress of the Bill through the House has been desperately slow. It was introduced in 2019 and there has been an eight-month delay in moving from Committee Stage to Report Stage. The Taoiseach has to bear in mind that it still needs to make its way through the Seanad, so I ask him whether the commitment he has just given, which is to have the Bill completed before the end of the year, includes its passage through the Seanad.

Progress on another important development has also been far too slow. The State's only cervical screening lab, at the Coombe hospital, is currently only screening private smears. Public screening, including screening for CervicalCheck, stopped after the cyberattack, although private work continues in the laboratory. Meanwhile, 160,000 slides were sent to the United States for analysis in just the first seven months of this year. There was a commitment in the wake of the CervicalCheck failures that the analysis of these slides would be carried out in total in Ireland. Four years later, that has not happened.

Vicky Phelan was always adamant that action was important to her, not platitudes and empty promises. When can we expect that the commitments made to Vicky and the other women who are victims of this failure will be honoured? When will mandatory disclosure be the law of the land in its entirety? I am talking about the passage of the legislation through both Houses. When is it expected that the new national cervical screening laboratory will be fully staffed with appropriate staff and operating? When can we expect all CervicalCheck slides to be processed in Ireland?

Micheál Martin (Cork South Central, Fianna Fail)
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I thank the Deputy for raising those issues. I dealt with some of these questions earlier but will deal with the specifics again.

On the national cervical screening laboratory at the Coombe, the building is complete. It was completed in October. It is expected that it will become operational by the end of the year.

Róisín Shortall (Dublin North West, Social Democrats)
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There are no staff-----

Micheál Martin (Cork South Central, Fianna Fail)
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Sorry, I am answering the question. A workforce plan is in place. Recruitment for the new laboratory is an ongoing priority for the HSE. It is working with the faculty of pathology to build the required expertise. As already stated, Dr. Cillian De Gascun was recently appointed as interim director of the national cervical screening laboratory. A lot will depend on the pace of recruitment. It is a matter of high-level expertise. Thankfully, new technologies that reduce the capacity for human error have emerged for cervical screening. There is a far more significant and enhanced process now than pertained originally.

That is positive. Ultimately, the new laboratory is designed to become CervicalCheck's main provider of cervical screening laboratory services. The HSE is of the view, however, that a secondary laboratory contractor will remain necessary at all times to ensure resilience in the system. The route to go is to create our own national service in respect of this. That then, combined with the HPV vaccine roll-out, would give us a very robust approach to cervical cancer and a real opportunity to eliminate it or significantly reduce it in this country.

In respect of the legislation, Deputy Shortall will know that down through the years there have been various debates around mandatory reporting in different areas of life, for example, child protection, where many professionals believe it can be counterproductive, or at least that was the argument that was advanced. I have never been of the view that the world collapses if we do certain things. My view is that open disclosure is imperative and can be of benefit to the system. On the legislation, the Government and I are at the mercy of the House. To be fair, we do need to produce the amendments, complete Report Stage and the Bill then needs to go to the Seanad. If there is agreement on the amendments and if the Bill satisfies all parties, then I think we can move it through both Houses in a timely manner. We are committed to doing that. I will ask the Minister to engage with his respective counterparts on the legislation.

I will make a general point, which is that the cervical screening programme has saved thousands of lives. It is very important that we continue to advocate for participation in the programme. We can certainly improve and enhance it, and that is what we are about.

Róisín Shortall (Dublin North West, Social Democrats)
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I do not think anybody would disagree with the importance of population-based screening. We would all encourage women to participate in CervicalCheck. However, we must deliver on the promises that were made when the failures in CervicalCheck were identified.

In addition to the two points I raised with the Taoiseach, there are three outstanding commitments from the Scally report that must be actioned. These include the commitment to ensure that clinicians meet with their patients or the families of patients who are deceased in order to discuss the failures of the system and the failure to inform them of the outcome of the review of smear tests. That has not been actioned yet. Two other commitments relate to data retention and the implications for other Departments in terms of the learnings from the Scally report.

In December 2020, Judge Meenan issued a report on medical negligence. That has also not been actioned yet. Can the Taoiseach update the House on when we are likely to see progress on each of those issues?

Micheál Martin (Cork South Central, Fianna Fail)
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In terms of the clinicians meeting with their patients, I will follow through with the Minister and get a response for the Deputy on where that matter stands. That should have happened. It has happened in a number of cases.

On the implications for other Departments, all Departments will take on board lessons learned from the CervicalCheck scandal and will follow through on best practice in respect of disclosure.

The medical negligence report has been completed and more work is required in regard to it. I will come back to the Deputy with a more comprehensive and detailed response in respect of that issue.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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This morning, I attended the press launch of the Raise the Roof campaign at which trade unions, student unions, housing groups, anti-poverty groups and many more, including Opposition parties, outlined details of the national housing demonstration that will take place in Dublin city centre on the Saturday after next. We expect many thousands of people to take to the streets to demand action that has not been forthcoming from the Government to address the shameful, intolerable, ever-worsening housing and homelessness crisis.

There are many reasons for the crisis. I urge those affected by or angry about the crisis to come out on the Saturday after next. The reasons for the crisis include: the failure of the Government to control rents and house prices to make them affordable; the failure of the Government to stop the constant flow of families and individuals into homelessness and emergency accommodation; the failure to deal with the scandal of empty properties; and the failure to deal with vulture funds and property speculators that profiteer and benefit from the housing and homelessness crisis.

I want to ask the Taoiseach about another reason that people should come out on the streets, that is, the Government's commitment to the Comprehensive Economic and Trade Agreement, CETA, between Canada and the EU. Last Friday, as a result of Deputy Costello's Supreme Court action, we found that CETA is, at least at the moment, unconstitutional because it has the potential to bypass the sovereignty of the court system and fundamentally undermine democracy in the interests of multinational investors. I want to ring the alarm bells about this matter for the public and remind them what is at stake here. In simple terms, the agreement gives multinational companies the right to sue governments that introduce progressive legislation or regulation to deal precisely with matters such as the housing crisis, environmental issues or workers' rights by means of a system that bypasses our courts. I refer here to the investor court system. Despite this, the Government continues to be committed to this attack on democracy in favour of the profits of multinational companies. This opens up the potential, for example, for property speculators and investors to sue governments that introduce measures to protect tenants, control rents and regulate the behaviour of vulture funds, property speculators and so on. Yet, the Government remains committed to this unconstitutional agreement and refuses even to agree-----

Catherine Connolly (Galway West, Independent)
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I thank the Deputy. We are over time.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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-----to a referendum whereby the people could debate and vote on whether they want to be part of this dangerous agreement.

Catherine Connolly (Galway West, Independent)
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I remind the Deputy he has raised two issues under Leaders' Questions.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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No, I did not. I connected the housing issue to CETA.

Catherine Connolly (Galway West, Independent)
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Well, on the two issues I am not sure so I am going to let the Taoiseach-----

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I am saying it is another reason with CETA.

Catherine Connolly (Galway West, Independent)
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I am going to let the Taoiseach deal with whichever issue he wishes to deal with.

Micheál Martin (Cork South Central, Fianna Fail)
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A good polemicist and a great propagandist can often conflate issues and spin them to his heart's content, which is what Deputy Boyd Barrett has done. However, he has done it in a very disingenuous and, dare I say, dishonest way in his presentation and his attempt to conflate the two matters. Suffice it to say that I have repeatedly stated in this House that housing is the greatest social issue facing this country and the Government's number one priority is to deal with it. The Minister for Housing, Local Government and Heritage has brought in a raft of not just legislation but also schemes to deal with the housing issue. We need to build houses more rapidly to help younger generations get access to houses they can afford and that they can rent at affordable levels. That might be affordable housing, social housing, cost rental, the refurbishment of existing houses or any other initiatives we can take.

The Supreme Court ruled in respect of CETA, and I welcome the clarification in its judgment. The court did not rule on the principle of free trade but rather on a point of law, which can be remedied. The decision of the court was six to one in favour of the view that an amendment to the Arbitration Act can deal with the issue and that, consequential on such an amendment, CETA can be ratified

. What is this great danger the Deputy wants alarm bells to go off all over the place about? He never says it or references it. He talks about multinationals, developers and vulture funds. He does not talk about the 400 companies that employ many people in this country. These are Enterprise Ireland client companies, many of them startups and many of them small operations, that trade with Canada.

This agreement is operational since 2017. The only real impact of this agreement is a 30% increase in trade between Ireland and Canada to the benefit of our companies and to protect jobs. What does Deputy Boyd Barrett want? Does he want every trade deal the European Commission does with a country like Singapore or Japan to go through a referendum?

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Does the Taoiseach want parallel courts to cover it?

Micheál Martin (Cork South Central, Fianna Fail)
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Free trade is the esprit de corpsof this country. Since the 1960s, we have fundamentally changed an insular approach to an external approach by joining the European Union and embracing the Single Market. Why? Because we sell 90% of everything we make in this country, be it services or merchandise. We sell and export to create wealth and jobs in this country.

Deputy Boyd Barrett's diatribe and his reading of the riot act to me is anti-enterprises, anti-jobs and against the best interests of this country. Is the Deputy for free trade or not? Will he answer that question when he gives his supplementary response?

Catherine Connolly (Galway West, Independent)
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Thank you, Taoiseach.

Micheál Martin (Cork South Central, Fianna Fail)
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We export €4 billion to Canada, which is a country that abides by the same liberal democratic values as we do and which is as committed to climate change as we are.

Catherine Connolly (Galway West, Independent)
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We are over time.

Micheál Martin (Cork South Central, Fianna Fail)
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Nothing in CETA can stop us-----

Catherine Connolly (Galway West, Independent)
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Deputy Boyd Barrett to answer.

Paul Murphy (Dublin South West, RISE)
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We are certainly committed to raising our rents.

Micheál Martin (Cork South Central, Fianna Fail)
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-----or can in any way damage our Constitution or, indeed, the values of the European Union for that matter.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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We can develop trade between Canada and any other country without introducing a system that bypasses the court system and which favours multinational investors. I will tell the Taoiseach what I do not want, and this is the connection between housing and CETA. I do not want what has happened to the United States, which is that the National Apartment Association, which represents big investors in apartments, has taken the US federal court to court through the investor court system and is claiming billions in losses because of the introduction of a moratorium on evictions. That has just happened in the United States. This is not a hypothetical danger.

Who is the biggest apartment owner in this country? IRES REIT. Who is its parent company? A Canadian property company. Therefore, if the Government were to introduce regulations that controlled or reduced rents or regulated the behaviour of vulture funds and speculators that are benefiting from the housing crisis, we could be sued through the investor court system, as governments have been on a whole range of environmental issues. The French Government has been sued over trying to limit fossil fuel extraction, for example.

Catherine Connolly (Galway West, Independent)
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Thank you, Deputy. We are over time.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Minister, Deputy Eamon Ryan, told this House that we could not ban further fossil fuel extraction because of the threat of possible legal action by fossil fuel companies.

Catherine Connolly (Galway West, Independent)
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We are over time. The Taoiseach to respond.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Do not say this is a red herring. It is true, and you will not even let people have a say on it.

Micheál Martin (Cork South Central, Fianna Fail)
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No, it is not true, actually. The Supreme Court is clear. If the Arbitration Act is amended, the point of law that was raised can be dealt with.

Paul Murphy (Dublin South West, RISE)
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It is actually not the case. Read the judgment.

Micheál Martin (Cork South Central, Fianna Fail)
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Sorry, hold on a second. No country can be sued for adhering to the European Union treaty. It is daft to suggest it could be. It cannot.

Paul Murphy (Dublin South West, RISE)
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Romania was sued by a Canadian mining corporation.

Micheál Martin (Cork South Central, Fianna Fail)
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Neither can any country be sued in respect of upholding its own constitution.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Eamon Ryan told this House we would be sued.

Micheál Martin (Cork South Central, Fianna Fail)
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That would be the effects of the amendment to the Arbitration Act.

Micheál Martin (Cork South Central, Fianna Fail)
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The Deputy should not scaremonger in the hypothetical manner he does and raise the one issue.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The Taoiseach should read Eamon Ryan's comments on the climate emergency Bill.

Micheál Martin (Cork South Central, Fianna Fail)
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I have read about and taken far more substantive advice on this question than Deputy Boyd Barrett has and I can say to him very clearly-----

Paul Murphy (Dublin South West, RISE)
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A Canadian mining company took Romania to court.

Micheál Martin (Cork South Central, Fianna Fail)
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It is not your question, Deputy Murphy; it is Deputy Boyd Barrett's question. Have some respect for the norms of the House.

Paul Murphy (Dublin South West, RISE)
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You are saying it cannot happen. It has happened.

Micheál Martin (Cork South Central, Fianna Fail)
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I will repeat what I said. An amendment to the Arbitration Act takes out any theoretical issue, which is theoretical rather than hypothetical at this stage. We are bound by European Union treaty-----

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Read the judgment.

Micheál Martin (Cork South Central, Fianna Fail)
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-----and by the decisions of the European Union treaty, as we are by our own Constitution. By the way, investor courts or mediation forums are part of every standard trade agreement, so you need to come clean.

Catherine Connolly (Galway West, Independent)
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We are over time.

Micheál Martin (Cork South Central, Fianna Fail)
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You lot over there need to come clean on where you stand in relation to free trade.

Catherine Connolly (Galway West, Independent)
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Thank you. Taoiseach, we are over time.

Micheál Martin (Cork South Central, Fianna Fail)
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It seems to me if your policies came to fruition, you would grind trade from this country to a halt. That needs to be called out.

Catherine Connolly (Galway West, Independent)
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We are moving on to the fourth and final question from the Regional Group. I call Deputy Cathal Berry.

Cathal Berry (Kildare South, Independent)
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I wish the Taoiseach a good afternoon.

It is appropriate that we focus on healthcare reform for the day that is in it. There can be no better way of honouring the memory of Vicky Phelan than to focus on and accomplish what she was advocating for, namely, healthcare reform. We want to fix our broken health service to minimise errors and maximise excellence in all its forms. As the Taoiseach and colleagues are aware, I am not interested in HSE bashing in any shape or form. On the contrary, I recognise there are small pockets of excellence all over the health service in every hospital and primary care centre. Our job as legislators is to support these people so we can build on their success. The problems in the health service can be fixed by the good things in the health service, but only if we get our people right. I have three people-related questions for the Taoiseach. People are everything. They are the ultimate precondition to success. If we get our people right, problems melt away, and if we get them wrong, we are chasing our tail for the rest of our days.

The position of chief executive of the HSE has been vacant for some time now since Paul Reid retired or resigned. Where are we with his replacement? Are we likely to get a replacement before Christmas? It is very important we have the corporate governance and accountability in place. We also have 900 consultant vacancies, almost a fifth of the consultant workforce throughout the country. Some positions are unfilled, partially filled or filled by locums. It is very disruptive to the health service. Negotiations on the consultants' contract are ongoing. Are we likely to get agreement on that by Christmas so that we can recruit and retain consultants and ensure appropriate clinical governance and accountability is in place? The new regional health areas, RHAs, are entities designed to streamline the hospital groups and community health organisations, CHOs. Where are we in establishing them? When does the Taoiseach envisage them to be established and made operational to ensure we have the appropriate structural governance and accountability in place? Those are the three questions: regarding the chief executive, the consultants and the RHAs.

Micheál Martin (Cork South Central, Fianna Fail)
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I thank the Deputy for raising this issue. It is important in terms of the improvement and enhancement of our health services. It is very much grounded in recruiting expertise and personnel. Since 2020, a net 15,000 personnel have been recruited to the health service, which is the highest ever number recruited in the HSE since its establishment or indeed in the health service. Huge numbers have come in. Obviously, the population is growing. Services are expanding and in many instances are getting better. I was at a stroke centre at the weekend in Cork University Hospital. There are 26 such stroke centres throughout the country. Wherever we get centralisation and a strategic view in terms of a particular disease, great benefits can accrue. Going back to the late 1990s and early 2000s, we had a cardiovascular strategy and the first national cancer strategies, all of which led to improved survival rates. Likewise improvements in stroke care have had a dramatic impact. I would say, in health services overall, having that strategic framework and focus is key, which has to be followed through by implementation. Personnel is key, of course.

The consultants' contract negotiations are progressing in a constructive way between the Minister and team in the Department of Health and the representative bodies. We had a Cabinet subcommittee on health yesterday and we were updated on progress. I would hope that we can bring that to a conclusion as quickly as possible. It is very important we bring clarity to it in line with the expressed wish of most people in this House. That would yield better coverage overall in the health service and better outcomes and treatments for patients.

Work is ongoing on implementation of the regional health areas as outlined in the programme for Government. The Minister brought a memo to Cabinet in April last. An implementation plan will be finalised by the end of the year. The RHAs will have population-based budget allocations and will be responsible for providing health and social care services.

Integration between acute, community and primary care will be key. The recruitment will start early next year for the senior posts and the RHAs will be responsible for recruitment, financial management, service planning and delivery. Transition to RHAs will take place throughout 2023. Funding has been approved in the budget for the appointment of the RHA senior leadership teams and the aim is to have them operational before the end of 2023. If we can bring that forward we will do so but it is a significant structural change from what we have so it will take a bit of time.

Cathal Berry (Kildare South, Independent)
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The RHAs, in particular, are vital. It is very unusual to have six hospital groups and nine CHOs and for them not even geographically to align so I hope that will streamline the process. It is also reassuring to hear about the consultants' contract. If that can be done by Christmas it would make a massive improvement downstream because you are not just hiring managers or people with clinical governance; you are hiring expertise as well. The old medical adage that prevention is better than cure is an appropriate one. If you get the right people in the right place you can solve problems before they even start, stop mistakes and focus on excellence from there. Hopefully that issue will be solved by Christmas.

Micheál Martin (Cork South Central, Fianna Fail)
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It is our wish that we will have this issue solved in advance of that timeline but that is still a matter for the discussions and negotiations. Following agreement we would intend bringing in a new contract hopefully to ramp up the recruitment of more consultants.

On the RHAs, good consultations and engagement with health sector stakeholders have been held and more are scheduled. These include a workshop of the voluntary dialogue forum and six regional events were held for health service workers in Cork, Sligo, Kilkenny Tullamore, Dublin and Limerick in September and October. We are making progress on those fronts.

Catherine Connolly (Galway West, Independent)
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Before we move on I want to say that it is extremely difficult to chair the debate with the constant interruptions and it must be difficult for the speakers as well. I hate to draw Members' attention to it repeatedly but if phones and various other items could be turned off that would be helpful.