David Cullinane (Waterford, Sinn Fein)
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The news today that charges on most toll roads are to increase to their maximum level from 1 January is another blow to workers and families. It comes on top of the record fuel prices that motorists are paying. As the Tánaiste knows, workers and families are struggling to get by and these toll increases will really hurt commuters. Tolls disproportionately impact those living in rural areas who are forced to use a car because public transport is not an option. During the pandemic the taxpayer had to step in and pay the toll operators millions. Now, due to these gold-plated Fianna Fáil-era contracts, motorists will be forced to fork out even more. Last month the M3 toll operator alone announced a profit of €11 million. These firms are not struggling to get by. Will the Government engage with the operators? Has it asked them to forgo this hike?

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy. I am informed the setting of tolls is not a Government decision. It is a statutory function of Transport Infrastructure Ireland, TII, although there are some procedural differences between the two public roads, which are the M50 and the Dublin Port tunnel, and the eight PPP roads. Obviously, news of the increase is not welcome. The M50 toll is in my constituency. The Deputy can imagine that many people travel south and north and pay that toll not just every day but twice a day. This is very unwelcome. As is required by legislation, TII will shortly publish details of the proposals in the national media prior to their introduction. From the Government's point of view, we can take it up with it at that point. I do not want to make a commitment I might not be able to honour. The power to decide the toll levels does not lie with the Government. It lies with TII.

Ivana Bacik (Dublin Bay South, Labour)
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I want to return to the issue of women’s healthcare and the CervicalCheck screening programme. On Tuesday we all spoke in tribute to Vicky Phelan and remarked on the extraordinary legacy she has left and the huge work she did for women's healthcare in her lifetime. On Tuesday, the Tánaiste and the Taoiseach committed to ensuring the speedy passage of the Patient Safety (Notifiable Patient Safety Incidents) Bill 2019 to require mandatory open disclosure and restorative meetings between women and their consultants. This is very welcome. The Tánaiste identified some of the very positive outcomes as a result of the Scally report. More accurate ways to examine the smear tests are now in place and funding has been allocated for a new laboratory in the Coombe hospital to reduce the need for outsourcing. Many of us have been contacted in recent days not just about the Scally report and those changes but also about the 2019 rapid review report of Professor Brian MacCraith looking at the delays in issuing cervical screening retest results to a large cohort of women and their doctors. Will the Tánaiste confirm that the findings of the MacCraith review, which were accepted entirely by the HSE, as we know, have now been implemented along with the Scally report recommendations so that no more women will face the sort of delays that led to such adverse outcomes in the past?

Leo Varadkar (Dublin West, Fine Gael)
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I thank Deputy Bacik. I certainly hope they have been implemented or, if not, that they are in the process of being implemented. I cannot confirm that now for the Deputy. I will certainly let the Minister, Deputy Donnelly, know Deputy Bacik has raised it and I will ask him to come back to her directly.

Ivana Bacik (Dublin Bay South, Labour)
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I thank the Tánaiste.

Jennifer Whitmore (Wicklow, Social Democrats)
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It is disappointing the Minister for Health is not here because I was hoping for an answer to this question. I want to raise the issue of Miley McKee again. I raised it three weeks ago. Miley is a 12-year-old girl from Greystones. She has been waiting two years and four months for her scoliosis treatment. She has a curvature of more than 100° and is in constant pain. As a GP, the Tánaiste knows the impact having a curvature of that degree would have on a child. She has been waiting since August 2020. She was meant to have her operation in September. It was cancelled because there were not enough paediatric nurses to look after her after the operation. A tracheostomy nurse was required. When I asked Children's Health Ireland this week how many tracheostomy nurses it has, it quite flippantly replied that it has a large number of tracheostomy trained nurses in Temple Street hospital. Why is it not using one of that large number of tracheostomy nurses to make sure that Miley gets the operation she needs? She is in constant pain. I do not say this lightly. This is actually child abuse. When will Miley have her operation?

Leo Varadkar (Dublin West, Fine Gael)
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I am very sorry to hear about Miley's experience. I was not aware of the case, although I appreciate Deputy Whitmore has raised it previously. As the Deputy knows, wait times for scoliosis have improved and reduced in the past year or so, but often there are individual cases and very complex cases that take longer because of the number of different specialists that need to be involved. I do not really want to comment on individual cases for these reasons. Perhaps I can let the Minister, Deputy Donnelly, know the Deputy has raised it again and ask him to come back to her directly.

Mick Barry (Cork North Central, Solidarity)
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When the moratorium on gas and electricity disconnections was announced for the winter, pay-as-you-go customers were excluded. There are 340,000 such electricity meters in the State and 117,000 such gas customers. If we exclude a certain crossover and perhaps some holiday homes, we are safe to say the households excluded from the moratorium probably comprise more than 500,000 people. This issue was highlighted in the Dáil and there was a subsequent furore, debate and controversy. Some concessions were forced as a result of this. The financial penalties for switching from pay-as-you-go to bill pay were removed. Some energy companies that previously had no hardship funds introduced hardship funds. However, there is still no moratorium despite the fact that the official start date of the moratorium, 1 December, is just two weeks away. What guarantee will the Tánaiste give to pay-as-you-go customers that they will not and cannot be disconnected this winter?

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy. I will have to check with the Minister, Deputy Ryan, who is attending COP 27 at present, to see what solution we came up with. I know it turned out to be quite complicated given the nature of bill pay being different from pay-as-you-go. As the Deputy acknowledged, there are no disconnections at certain times such as weekends. We were trying to make it easier for people to move from pay-as-you-go to bill pay without having to pay €160. I am not sure where it ended up. I know the Department with responsibility for energy was doing some work to try to find a solution for the very reasonable issues Deputy Barry has raised. I will check the Minister, Deputy Ryan, and his people and see whether I can come back to the Deputy later.

Michael Lowry (Tipperary, Independent)
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The Government must explain to the public what it is doing to address the dangerous staff shortages in our health service. The situation has gone beyond crisis point when midwives in Tipperary University Hospital have issued a warning that staff shortages are causing risks to the safety of women and their babies. INMO members working in the maternity department have formally written to the management at the hospital stating they cannot be held accountable or responsible for any adverse event that might occur. We have reached an alarming situation where nurses in the hospital are in fear of being blamed for unfortunate outcomes caused directly by gross understaffing. The greatest asset of any organisation is its people. The provision of healthcare simply cannot function safely without sufficient staff. The serious staffing problems at Tipperary University Hospital's maternity unit need to be addressed urgently.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy. We are actively recruiting people for our health service domestically and abroad. Approximately 130,000 or 135,000 people work in our health service, which is more than ever before. There are 81,000 nurses and midwives, which is more than ever before. We have never had more doctors or consultants working on our health service than is the case now. This, of course, comes against a backdrop of a rising population, increasing medical needs and a move towards shorter hours and more part-time work. We are doing everything we can to recruit and we are seeing some success in this regard. With regard to Tipperary specifically, I do not have information but I will follow it up through my office to see whether we can get more information to provide the Deputy.

Michael Collins (Cork South West, Independent)
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I have raised the crisis regarding Dursey Island off Castletownbere on numerous occasions, mainly because the world-famous Dursey cable car has been suspended for number of months due to the repair works being carried out. The islanders and landowners are anxiously awaiting the cable car works completion, which has been put off due to inclement weather. I spoke to the islanders and landowners there in the past week. They have had no way on or off the island for almost two weeks. The temporary ferry service put in place has not been able to travel due to inclement weather, leaving no access to the island. This is an emergency.

A helicopter service must be put in place immediately for the people of Dursey Island so people can get food and get onto the island to feed their cattle, as well as a derrick being provided on the mainland, which the islanders have said would also help them. The people of Castletownbere and Dursey Island have been failed badly by this Government throughout this saga. There have been many promises, but little delivery.

Leo Varadkar (Dublin West, Fine Gael)
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I appreciate this is an important issue for people on Dursey Island and in Castletownbere. I do not have an update to hand and do not want to give information that may turn out to be false. However, I will get my office to follow up with the Deputy on this to see if we can find more information.

Joan Collins (Dublin South Central, Independents 4 Change)
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I was contacted this week by Thomas Barry regarding his brother, who has serious health issues and has been in hospital for more than two years and in and out for over five years while waiting on permanent residential care. This will be Thomas's brother's fourth Christmas in St. James's Hospital if a residential placement is not secured for him. He frequently leaves the hospital and makes his way home, causing much anxiety for himself and his family. Gardaí are frequently asked to intervene. I received a response from the disability services that states "mental health services have agreed to work with us around sourcing an accommodation solution that will enable him to live away from the family home with appropriate supports". That is dated 19 August 2020, and he is still waiting for that permanent care. I am asking for an intervention at the highest level to ensure this young man gets a permanent placement in residential services as soon as possible.

Leo Varadkar (Dublin West, Fine Gael)
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I am sorry to hear about this man’s experience and that of his family. As the Deputy will understand, it is not within the power of a Minister to intervene to allocate people housing or residential care. This is not how the system works, and I am not sure it would be fair if politicians were the ones who decided who got residential care and who did not.

Joan Collins (Dublin South Central, Independents 4 Change)
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The HSE has not done it for two years.

Leo Varadkar (Dublin West, Fine Gael)
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If the Deputy passes on the details, we will definitely follow up on it and will be happy to. Again, I do not want to create the impression that Ministers allocate housing. That is not the case.

Éamon Ó Cuív (Galway West, Fianna Fail)
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The process involved in getting approval for major hospital developments is both contracted and convoluted and includes multiple stages, many times with significant delays at each stage. The reality is these delays make it very difficult to provide good quality services because of overcrowding and inadequate buildings. The second factor often overlooked is that, with building inflation costs running at a high level, the longer the delays, the more it costs the taxpayer and the less we get in results. What steps is the Government taking to reduce the whole process and streamline it so that we actually get things built in this country rather than talking about and planning them forever?

Leo Varadkar (Dublin West, Fine Gael)
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We discussed this at the Cabinet subcommittee on health on Monday, trying to figure out and carry out a review into how we might be able to speed up capital development in the health sector. The Deputy will be painfully aware that the development of an emergency department and of maternity and paediatric services in University Hospital Galway seem to be going on forever, which is extremely frustrating. There are similar examples in other parts of the country. However, there is a balance to be struck. Anything that is done more quickly with less review and scrutiny is more likely to go wrong, and we have seen this happen in other health projects. We are carrying out a review into the public spending code and whether we can reduce the number of steps and hoops a project has to get through to be built. I understand the Deputy's point that delays cost money.

Fergus O'Dowd (Louth, Fine Gael)
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I raise for the third time on Questions on Policy and Legislation the plight of some very vulnerable citizens, many of whom are elderly and in poor health, living in fuel poverty and in mobile homes, which are the most inefficient homes for energy in the country. They cannot benefit from the €600 energy credit because they do not have an ESB meter registered in their name. They get their electricity from the supply park operator. I have raised this issue with the Minister, Deputy Ryan, who promised to get back to me. I raised it with the Taoiseach, who promised to get on to the Minister, and I raise it now with the Tánaiste, because it is unacceptable these people, who need the benefit of heat and energy the most, face an uncertain winter.

Leo Varadkar (Dublin West, Fine Gael)
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I very much agree that if a person’s mobile home is his or her principal residence, he or she should benefit from the €600 credit. I think a solution has been worked out on Traveller accommodation, although I am not sure how that works. I know both Ministers, Deputies Humphreys and Ryan, are trying to work out a solution through energy bills or the social welfare system. I agree we need to sort this out. The intention was that every household would receive €600 in energy credits. A family or a person living in a mobile home, which is their principal primary residence, are a household. We have to find a way to fix this. I appreciate the Deputy's frustration in raising this issue three times. We will find a way.

Brian Stanley (Laois-Offaly, Sinn Fein)
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I raise the issue of primary care centres. As the Tánaiste knows, people are presenting at hospital emergency departments because they cannot get access to a GP or primary care services. The population of towns like Portlaoise has increased, and there is no primary care centre in the town despite the population is heading towards 30,000. There is also a shortage of GPs. The Tánaiste will be aware of this from his background in the medical profession. People are piling into hospital emergency departments and this is adding to the problems of these units, which are regularly raised in the Chamber. When will the capital programme on primary care centres be published, will Portlaoise be included in it and what is the position regarding funding?

Leo Varadkar (Dublin West, Fine Gael)
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We have a successful programme of building primary care centres throughout the country. I have three in my own constituency, all of which are working very well.

Brian Stanley (Laois-Offaly, Sinn Fein)
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I do not have any in my constituency.

Leo Varadkar (Dublin West, Fine Gael)
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I do not know about Portlaoise, to be honest-----

Brian Stanley (Laois-Offaly, Sinn Fein)
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The Tánaiste has three.

Leo Varadkar (Dublin West, Fine Gael)
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-----and I am not sure when the next capital programme is coming out. However, I will check it and get back to the Deputy.

Brian Stanley (Laois-Offaly, Sinn Fein)
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Perhaps the Tánaiste would send that on to me.

Leo Varadkar (Dublin West, Fine Gael)
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I will.

Richard Bruton (Dublin Bay North, Fine Gael)
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I welcome the Tánaiste's decision to merge the flexible working and the remote working Bills. I also welcome, in particular, the removal of criminal offences for employers to have a policy, even if they never required having one, the removal of excessive grounds for employers to refuse remote working, the introduction of a code of practice and a worker's right to complain. It shows the value of the pre-legislative scrutiny system. I am seeking assurance that there be no unnecessary delay in implementing this legislation. It is an important opportunity we must seize.

We have seen cases where companies have announced a blanket end to remote working. Thankfully, this was not in Ireland, but it shows the urgent need for legislation.

Leo Varadkar (Dublin West, Fine Gael)
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In making the decision to merge the two Bills, we took on board the report of the Oireachtas Joint Committee on Enterprise, Trade and Employment, of which the Deputy is a member, and listened to the views of employer groups and unions through the Labour Employer Economic Forum, LEEF. The plan is to insert the remote working provision into the Minister, Deputy O'Gorman's, Bill on Report Stage, which is supposed to be taken in the coming weeks. We hope it will get through the Dáil before the recess and perhaps through the Seanad. I expect to see that legislation enacted, if not by the Christmas recess, certainly by the Easter recess.

Pádraig O'Sullivan (Cork North Central, Fianna Fail)
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I again raise the issue of elective hospitals throughout the country, including in Dublin, Cork and Galway. A key focus for the Government has been their delivery and there have been multimillion euro announcements about them. The issue is we need to get on and build them. The crisis we have with trolleys and waiting lists is well documented, and these hospitals are required to tackle those waiting lists into the future. Can we please get on with the job in hand and actually deliver those hospitals?

Leo Varadkar (Dublin West, Fine Gael)
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I am a big supporter of the Government's plan to build elective hospitals in Dublin, Cork and Galway to reduce waiting lists. Bearing in mind what Deputy Ó Cuív said earlier, I am realistic and I believe these new elective hospitals will be five or six years in planning, design and building. That is not good enough, so we need interim solutions as well. We already have elective hospitals, for example, Cappagh hospital, the Eye and Ear Hospital, and in Croom, which could potentially do more. There is a very successful surgery hub in Tallaght that has helped to reduce waiting lists dramatically. We need to have a parallel track, including elective hospitals, but it will be close to 2030 before they are up and running, so we need to have other solutions as well.

Darren O'Rourke (Meath East, Sinn Fein)
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What is the Government doing in response to the shortage of primary school teachers in particular? The Irish Primary Principals' Network, IPPN, said we are at crisis point and pointed to acute shortages in Dublin, Cork, Galway and Kildare. I speak on behalf of my own constituency in Meath where I know the situation is exactly the same. Many issues are raised such as the cost of rents and pay inequality. I know there have been some responses with regard to student teachers and there are the sub-seeker and teaching transforms programmes. Is there a focus on this and a plan to address the acute shortage?

Leo Varadkar (Dublin West, Fine Gael)
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Pay increases for teachers kick in this week. Teachers will receive their pay increase from the Department of Education in their payslips this week and throughout the month. It includes the back pay to February, which will obviously help financially. We have a teacher shortage of which we are very much aware and we are working on solutions. I believe the IPPN conference is happening today, and the Minister, Deputy Foley, will be there and will engage with the IPPN. It has made some good suggestions to which we need to give good consideration. I am told that much of the shortage is linked to this move away from the HDip to a two-year masters, which has knocked out the best part of a year's supply. I am not sure whether that was anticipated but it ought to have been. However, it will wash its way out of the system.

Carol Nolan (Laois-Offaly, Independent)
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There is no clarity, certainty or adequate sources when it comes to peat harvesting. There is no clarity on where the authority to change the planning law resides. Is it with the EU or the Government? There is no certainty as to whether the horticulture sector can survive going forward. There are no adequate levels or sources of peat, or rather there are, but people are banned from accessing them. What has this Government got against the horticulture sector and why is the sector being made to carry the burden of unworkable environmentally incoherent policies? What actions will the Government take to address this crisis which is deepening by the hour? Peat is being imported from tens of thousands of miles away which is increasing the carbon footprint. What actions will the Government take for this sector?

Charlie McConalogue (Donegal, Fianna Fail)
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The Government has been taking this issue very seriously. It is a challenging situation that emanates from the fact that pretty much all the commercial peat extraction that is happening in the country is operating without licence or authorisation. That has been the situation for many years. As a result, we have come up against a situation whereby the industry has not been regularised and is finding it very challenging to become regularised. Along with the Minister of State, Senator Hackett, I have been working on a recently commissioned report undertaken by Mr. Séamus Boland of Irish Rural Link to assess the number of bogs in the country of under 30 ha to see whether there is potential in that regard. I also commissioned planning expertise advice from two eminent professionals to help companies guide them through the planning process. However, there is no getting away from the fact this is difficult and challenging. My Department is engaging with the Department of Housing, Local Government and Heritage and the Department of the Environment, Climate and Communications to try plot a way forward.

David Stanton (Cork East, Fine Gael)
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In the programme for Government, the Government has committed to holding constitutional referendums on at least three matters: extending the franchise in the presidential elections to Irish citizens outside the State, housing and Article 41.2.1° with regard to women in the home. I am also interested in a referendum on the Unified Patent Court which is urgent. Will the Tánaiste tell me whether there is a plan to hold any of these referendums in the coming six months or year?

Leo Varadkar (Dublin West, Fine Gael)
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We have not agreed dates for any of those referendums as of yet. It is fair to say that none of them will happen within six months. It takes a bit of time to plan for a referendum. My Department has begun the process of planning for the referendum on the patent court, which will happen no later than the local and European elections of 2024. We do not have dates for the referendums. We will need to have dates because a number of them probably should happen next year but it has not been agreed by Cabinet yet.

Peadar Tóibín (Meath West, Aontú)
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The increase in tolls during the cost-of-living crisis is an absolute disgrace. The Government owns the M50 and the East-Link Bridge, and yet we see the tolls for these increase at a time when people are paying higher prices for cars and fuel and to service their cars. The research Aontú carried out shows the commuter has already paid €1.2 billion for the M50 toll in the past nine years. The commuter has paid for this infrastructure ten times over at this stage. The traffic congestion in our cities and towns is an absolute disgrace and people are now paying extra tolls for the joy of sitting in traffic for three hours. The Tánaiste said it was not the Government's responsibility. I understand that the Tánaiste, when he was Minister for Transport, was behind the development of Transport Infrastructure Ireland, TII, which is responsible for this through the Minister for Transport. The M50 and the East-Link bridge are the Government's infrastructure. It could scrap those tolls now if it wished.

Leo Varadkar (Dublin West, Fine Gael)
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These toll increases and their scale are very unwelcome. I am not happy about them at all. The M50 toll bridge is in my constituency and many people travel north and south through it twice per day. I am not happy with the toll increases at all. It is a statutory function of TII, not a Government decision, but we will take it up with TII when it publishes the details of the proposal, as required by legislation. I do not want to make a promise I cannot keep but I want make it very clear this came as a surprise to Government - it certainly came as a surprise to me - and we are not happy about it.

Thomas Pringle (Donegal, Independent)
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It has been reported that the Government is one of the leading voices seeking to exempt financial asset managers and institutional investors from the scope of the corporate sustainability and due diligence directive under discussion by the EU. This is highly significant because financial institutions, assets and institutional investments have some of the highest greenhouse gas emissions in the world. If the reports are true, this would be a retrograde step by the Government in a week when its Ministers are at COP27 to signal their support for climate action and tackling greenhouse gas emissions in the face of a global crisis. Is the Government seeking to exclude financial asset managers and institutional investors from the scope of the EU corporate sustainability and due diligence directive?

Leo Varadkar (Dublin West, Fine Gael)
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I am not fully up to date on that and will have to ask the Minister, Deputy Donohoe, to respond to the Deputy.

Paul McAuliffe (Dublin North West, Fianna Fail)
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The Government has a very strong ambition to decarbonise the taxi fleet and it has in place a grant for taxi drivers to do so. This week, however, many taxi drivers who have applied and were approved for the grant and placed orders for e-vehicles have received notification that the grant will be cancelled and they will have to reapply next February, and that is because the vehicle cannot be licensed in this calendar year. However, the Deputy will know there are significant delays in the supply of vehicles. It makes no sense for people who have applied once to have to apply again. Some of them are in contractual relationships to buy those cars and now they have no certainty around the grant. All of this is due to a detail within the Government scheme. I ask the Tánaiste to raise this with the Minister for Transport and do everything he can to put a bit of reality to a scheme that makes a very positive contribution.

Leo Varadkar (Dublin West, Fine Gael)
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That certainly sounds strange and I doubt it was what was intended. I will certainly take it up with the Department of Transport. Even giving people reassurance that they do not have to reapply and the grant will be reissued might provide a solution, but I will certainly take it up with the Minister.

Réada Cronin (Kildare North, Sinn Fein)
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The HSE and the Department of Health management has eye-watering salaries and the perpetual luxury of learning lessons. In the week of Vicky Phelan's death we learned there has been no retrospective review of cervical slides for the past four years, despite recommendations to do so. This morning we learned that Tusla has spent €400,000 - nearly half a million - without tender, on a company managing information that is being withheld from the people it is about.

The lessons supposedly being comfortably learned are being lived extremely painfully by the citizens. My young constituent, Jack, was hospitalised with Covid - the same infection - for the third time in Crumlin hospital. This young non-verbal boy with Down's syndrome and additional multiple needs was left on a trolley for two days and two nights. This is an unacceptable trauma for Jack and his mam, Aisling. It is hard to imagine we are doing trolley counts now in children's hospitals. Where is the infection control for a child with Covid on a trolley? How many other children were put at risk because Jack was treated so disgracefully? Spare us the comfy lessons. Where is the real action plan for a functioning health service in this Republic?

Leo Varadkar (Dublin West, Fine Gael)
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I am very sorry to hear about the experience of Jack and Aisling, but we have done trolley counts in children's hospitals for a long time now, perhaps ten or 20 years. Thankfully, it is a much less common experience than in our adult hospitals but it happens in the winter period in particular. A new children's hospital is under construction and, in a few weeks' time, I will able to tell the Deputy that it will be open next year. I look forward to being able to say that and to see it happening. Contrary to what has been said, if you take the entire bed complement, including the day beds, there has been a significant increase in capacity. It will be in addition to the satellite units in Blanchardstown and Tallaght and will make a big difference for the better.