Mary Lou McDonald (Dublin Central, Sinn Fein)
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The controversy surrounding the Minister for Public Expenditure and Reform, Deputy Donohoe's undisclosed election donations raises again Fine Gael's relationship with big business and its influence at the heart of Government. The whole saga carries the stench of cronyism and favours for insiders.

The businessman at the centre of the controversy, Michael Stone, issued a statement today in which he revealed he gave a second undeclared donation to the Minister in the 2020 general election. This means the Minister failed not once but twice to disclose a donation in back-to-back elections from the same wealthy supporter. This is a supporter who has secured lucrative State contracts, was appointed to the powerful Land Development Agency by Fine Gael outside of the normal process and was appointed as chair of the north-east inner city programme implementation board. Mr. Stone has now resigned from both bodies. A theme of this controversy is the Minister’s ever-changing story, the muddying of waters and the ducking and diving to evade accountability. It has been an exercise in concealment and cover-up from start to finish.

This morning we have it again. Mr. Stone claimed the Minister asked him twice if he had paid for his postering operation in the 2020 general election and that he told the Minister he had not. Then, in a eureka moment as the Minister was being questioned on the floor of the Dáil, Mr. Stone remembered that he had paid for the postering in 2020. This is the farcical story the Minister asks the Dáil and public to believe but nobody buys it. The reason Mr. Stone had a sudden recollection is he knew they were caught out. The idea that this donation slipped through the net and out of memory does not stack up. The idea the Minister did not know and the businessman forgot does not hold water. Are we seriously supposed to believe neither the Minister, his director or elections nor any member of his campaign team knew anything of who was putting up the election posters? The posters had to be ordered, delivered and their distribution planned. Mr. Stone’s vans were crisscrossing the constituency putting up the posters and taking them down. People had to know Mr. Stone was taking care of the postering, and the Minister had to know also.

Tá sé seo an-dáiríre. Tá rud éigin aisteach faoi scéal an Aire, an Teachta Donohoe. Tá a chreidiúnacht i gcruachás. Caithfidh sé an fhírinne a insint. The Minister’s credibility lies in tatters. He has chosen concealment and cover-up again and again. At every turn, the truth has to be dragged out of him.

He was informed about the nature of the 2016 donation in 2017 and he did nothing. He denied there was anything to see when he was questioned by the media last November. It was only when the Standards In Public Office Commission, SIPO, wrote to him that was he forced to respond. When he was asked about the 2020 election, he denied the involvement of Mr. Stone. Indeed, we would know nothing of the 2020 donation had i not been for questions being put to the Minister in the Dáil last week. The Minister misled the Dáil last week. Now, to continue the cover-up, Michael Stone has fallen on his sword, all to protect the Minister.

Is the Taoiseach also standing by this story? Does he also claim that the Minister did not know and that the businessman simply forgot? As the head of the Government, does the Taoiseach stand by this account of events?

Leo Varadkar (Dublin West, Fine Gael)
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As the Deputy knows, the Minister, Deputy Donohoe, will make a statement before the House this afternoon and he will take questions on it. That will be an opportunity for the Deputy to put some of those questions directly to him, should she so wish. Once that process is over, once he has made his statement and once he has answered questions, it will be a matter for people to decide whether they believe Paschal Donohoe. I heard his explanations over the weekend. I spoke to him about it, and I believe him. I have fought four general elections and I know what can happen in a campaign, particularly in a chaotic campaign. There might be 1,000 posters and somebody might offer to put up 100 or 150 for you. They may offer to drop a few thousand leaflets for you. You do this on the assumption they are going to do it voluntarily. It is possible that they may pay a third or fourth party to do that for them and not inform you. That appears to me to be what happened in this case.

We have strict laws when it comes to election spending in Ireland, and we have them for a very good reason. We do not want it to be the case that people have to have hundreds of thousands of euro or millions of euro just to stand in an election. That is why we have spending limits that cannot be breached, and that were not breached, even inadvertently, by the Minister with respect to 2016 and 2020. We do not want to have the kind of politics they have in the United Kingdom, the United States, or indeed on other parts of this island, where politicians and political parties accept multimillion euro donations, which is something Deputy McDonald’s party has done, with questionable legality, quite frankly.

Paschal Donohoe has not breached the spending limits, as I have said. However, he or his agent did fail to account for some of the spending in 2016 and 2020, in the region of €1,000 to €2,000 on each occasion. Why did that happen? It was because he did not know. Once he found out the full facts, only after last Wednesday, was he in a position to file revised returns. I understand he has filed a revised return for 2016 and is in the process of filing a revised return for 2020. Once he found out the facts, he acted to amend his declaration. This is something that is allowed under the law. Deputy McDonald knows it is allowed under the law because her whole party had to file its election declarations on three occasions after the 2020 election because it neglected to include in its accounts a €7,000 payment to a British polling firm. Sinn Féin tried to claim it did that after it noticed the error itself. It was exposed on that, and it turns out it only found out about that after The Irish Timescontacted the party. Therefore, Sinn Féin filed its returns in 2020 three times because of errors that had been identified by the media. The sums involved were much greater than any sums involved in relation to the Minister, Deputy Donohoe. Therefore, the Deputy seems to be trying to apply a very different standard to him than she would apply to her own party.

Indeed, the Deputy needs to consider revising her own declarations. Her declarations show she received a personal donation of €1,000 from her friend, gangland criminal and Navan Road torturer, Jonathan Dowdall. Members of the Deputy’s party, who are around her, have claimed that was a donation to her party. That requires Deputy McDonald to decide which it was and to make an amendment to her own declarations, just as the Minister, Deputy Donohoe, has done.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Nice try. That is a nice try at a distraction. If the Minister for Public Expenditure and Reform has a very faulty memory, then I have to say the Taoiseach is of Olympic-level competence in trying to breed further distractions. This is what has happened. Every rule in the book has been broken. Spending limits, I suspect, have been breached. Certainly, a corporate donation was made by somebody who was not registered as a corporate donor.

But here is the rub: a very wealthy individual who is a beneficiary of State contracts and who is appointed to State boards is a donor to the then Minister for Finance. That is a matter of public interest, but the deliberate concealment of that, election after election, is a real cause for public worry. There is a need for accountability on this. The Taoiseach says the Minister will come before the House again, I imagine to spin the same cock-and-bull story he spun last week. I put it to the Taoiseach that it is not credible for him, on his own part, to attempt to stand over these donations that were undeclared and the cock-and-bull story his colleague has fabricated, after the fact, to try to cover his tracks.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy. Exposing her hypocrisy is not a distraction; it is simply telling the truth, something she consistently runs a mile from. She has some brass neck, quite frankly, in that regard given her party had to file its 2020 declarations on three occasions-----

Mary Lou McDonald (Dublin Central, Sinn Fein)
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That has nothing to do with donations.

Leo Varadkar (Dublin West, Fine Gael)
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-----because of a €7,000 payment to a UK polling company it had forgotten about until The Irish Timesquestioned the party about it.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Michael Stone did not pay for that, though, if that is your concern.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Let the Taoiseach answer, please.

Leo Varadkar (Dublin West, Fine Gael)
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The Deputy always wants to shout me down when she does not want to hear the truth, but this country is still a democracy-----

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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It is the truth. Answer the question.

Leo Varadkar (Dublin West, Fine Gael)
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-----and the Deputy is not in charge of it.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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You are.

Leo Varadkar (Dublin West, Fine Gael)
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As long as we are a democracy, people will be allowed to speak freely in our Parliament and I will continue to do so. The Deputy has some brass neck in this regard when we consider the Jonathan Dowdall donation, which was a personal donation to the Deputy, not to her party, and the fact her party had to file its own declarations on three occasions in 2020, something the Minister has not had to do.

What is a distraction is this snide reference to Mr. Stone receiving public contracts from the Government. The Deputy knows as well as I do that Ministers have no role in awarding commercial contracts to businesses, and trying to throw that out there under cover of privilege is a pure distraction. The reason the Minister and his agents did not declare the donations is they did not know they had happened. They did not receive or give the donation. No money was exchanged-----

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Michael Stone, under cover of darkness, stole Paschal's posters.

Leo Varadkar (Dublin West, Fine Gael)
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A service was provided, which they believed had been done on a voluntary basis, and once they found out about it, they made efforts to put things right.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Okay. Bang on.

Ivana Bacik (Dublin Bay South, Labour)
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Last week, I put several questions to the Taoiseach about ethical standards in Fine Gael, and I have just been sitting here, as we all have, listening to the exchanges between Fine Gael and Sinn Féin over dodgy donations and funny money, we might say. I know we are going to return to the issue later.

I want to raise with the Taoiseach an issue that is very serious because of the enormous real-life harm and consequences that have been inflicted on children and families as a result. I am speaking about the damning report of the Mental Health Commission, which has made unequivocal findings about the failings across the child and adolescent mental health services, CAMHS. They are appalling findings. One hundred and forty children have, apparently, been “lost” in the mid-west CAMHS system. There has been an abject failure to monitor children on anti-psychotic medication, chronic understaffing and long waiting lists. There have been two-year delays, we were told, for follow-up appointments, young people reaching 18 with no transition to adult services, and an appalling and endemic lack of organisation across the service.

The findings are shocking and, behind the staggering figures and statistics, there are real children and families, some of whom will suffer lifelong consequences as a result of the failings detailed in the report. I am thinking about the 46 children in south Kerry CAMHS found to have suffered significant harm, as detailed in a report we saw last year, and of the 13-year-old girl written about by Kitty Holland in yesterday's newspaper, who was told, when she was engaging in self-cutting, that she was too high risk to receive help from the charity Jigsaw but not high risk enough to receive support from CAMHS. This was a child with a suicidal diagnosis, left in limbo. It is unthinkable that this is happening in today's Ireland, that children are being sold short in such a way.

It is not just mental health services for children, because a record-breaking 46 children are reportedly waiting on trolleys in hospitals today. That is not how children should be cared for in a republic, with persistent failures of clinical oversight and delivery of services to children in need of mental and physical health services.

The Taoiseach committed to setting up a unit on child poverty in his Department, as part of his nomination speech in December, but will he commit to ensuring children will receive the necessary health services that are clearly not currently available?

Will the Government outline the parameters of the clinical review being conducted by the HSE into all open cases in each CAMHS team so we can see the true extent of failures for children? Will the Government ensure, as a priority, the immediate regulation of CAMHS under the Mental Health Act 2001? We need to see that legislation progressed. On "Morning Ireland" earlier, the Minister for Health, Deputy Donnelly, was somewhat evasive in his response to the question on legislation, yet we know that gaps in the Mental Health Act have left Ireland significantly out of line with international human rights standards regarding mental health services for children. There was a review ten years ago stating that we need to see all parts of existing legislation relating to children's mental health put into one stand-alone Bill. We need to see proper statutory regulation of this service.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy. The Mental Health Commission's interim report into CAMHS is of great concern to me and to Government. The Minister for Health gave us a briefing on it at Cabinet this morning. Any of us working in politics who have a constituency service, anybody who has worked as a GP and many parents will understand that we have had problems in our CAMHS service for quite some time. Many children get very good care from CAMHS but it also falls short for a lot of children. It is a matter of resources, although they have been improved a lot in recent years, and an issue of governance, which needs to be resolved. I am particularly concerned to hear of children who have been prescribed antipsychotic medications being lost to follow-up. That falls very far below the basic standard of care that should be expected in any country. Child or adult, if somebody is prescribed antipsychotic medicines, they have to be followed up, not just six months later, probably even more frequently than that. I am very concerned that occurred and I wish to better understand why it occurred. The HSE is now contacting all of those so-called open cases to make sure those children are being looked after and they get the care they need.

Like the Mental Health Commission, I thank the young people and their families who spoke to the commission and shared their experiences of the CAMHS service. I know it will not have been easy for them and it is incumbent on us to listen and ensure action is taken. The Minister of State, Deputy Butler, has been clear on this. I will meet with her and the HSE later this week to follow up on the issue. The Minister of State asked for the Mental Health Commission to expand the remit of its report, which is why these findings are now in the public domain. I am advised there is an ongoing exercise of engagement between the Department, the HSE and the Mental Health Commission regarding the findings. It is essential that a full review of open cases by the HSE now takes place to ensure all children and young people are receiving the appropriate care they need. I am told this is under way. The HSE will arrange further clinical follow-up for any child, where required, and it will make direct contact with parents and guardians as necessary. If parents or guardians have a concern, they are invited to contact their key worker. In terms of other actions that will take place this year, a new youth mental health lead post will be created so that there is better clinical governance and clinical control in this area. A new assistant national director level in the HSE will also be created to make sure there is better management.

Regarding Deputy Bacik's questions on the clinical criteria, I do not know the answer. I will ask the Minister of State to come back to her about that. The Government absolutely commits to improving our paediatric and mental health services. They are good by international standards but below the standard we would wish them to be. We are going to do everything we can to raise them in the period ahead. We are going to give consideration to the Mental Health Commission's proposal that it should be allowed to regulate CAMHS. On the face of it, I think it is a good idea, but we need to do the work and the due diligence before we can definitively commit to that.

Ivana Bacik (Dublin Bay South, Labour)
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I thank the Taoiseach for his response but it does not sound as if he and the Government are bringing the necessary urgency to this. I am conscious, as I think we all are, that Dr. Susan Finnerty found her findings so stark that she published them as an interim report. There is an urgent need for action to address that report. As I said, it is over ten years since an expert group recommended reform of the Mental Health Act to ensure all parts of existing legislation relating to children would be in a separate stand-alone section setting out child-specific guiding principles in line with international human rights standards. That is the sort of overall governance the Government needs to be leading on.

The Taoiseach said the Government would give consideration to it but we need to hear more urgency from him about putting in place the necessary framework in order that the services can be delivered to the children who are being currently failed. I would like to hear from the Taoiseach what the parameters are for the HSE review into the open cases. The Taoiseach stated he does not have that available. I would like to hear about the timeline of the amendment of the Mental Health Act.

Finally, can the Taoiseach accept the calls of organisations like Neurodiversity Ireland, which are seeking an urgent round-table discussion with stakeholders, parents groups and clinicians to address the devastating situation for children's mental health services?

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy and completely agree that urgent action is needed. I will be following up on this personally later on in the week, alongside the Minister of State, Deputy Butler, ensuring that the whole of the Government is behind her, the Department of Health and the HSE in taking the actions that are needed. As I mentioned earlier, a new clinical lead will be appointed in youth mental health to ensure we have the clinical leadership and governance which is required. In addition, a new assistant national director will be appointed for CAMHS to ensure that we have the senior management.

Ivana Bacik (Dublin Bay South, Labour)
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Can the Taoiseach say when?

Leo Varadkar (Dublin West, Fine Gael)
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I do not want to make that commitment here until I have had that meeting but as soon as I can answer that question, I will. I point out that there has been a great deal of investment in CAMHS in recent years. There has been a marked increase in staffing in the community, for example. Fewer than 400 full-time staff worked in CAMHS in 2011 and it is now over 659. Much investment has been made in recent years but clearly, we will need more investment in staff, in management and in clinical governance.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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One of the reasons the issue of a political donation to Deputy Donohoe is so damaging to politics is because it is distracting from issues that would otherwise be dominating the debate and discussion in this House this week.

One of those is the utterly scandalous and unacceptable proposal by Coillte to partner with an UK equity fund to buy up thousands of hectares of land and forestry in this country where public money and a public company in which the Minister of Finance owns 99% of the shares will be subsidising and facilitating a corporate takeover of Irish land and forestry that could reach up to 100,000 ha, as part of Coillte’s plan for afforestation. This is 250,000 acres, which is an area the size of County Carlow, to be potentially handed over to vulture and equity funds. That is completely unacceptable.

I wish to inform the Taoiseach that this Thursday, to coincide with the special debate on Coillte which we requested and the Government has allowed, there will be a protest outside the Dáil organised by the recently-established Save Our Forests – Save Our Lands alliance. This alliance now involves about a dozen different rural organisations, environmental groups, community groups and so on that are completely outraged, as are many of those organisations representing people who work and earn their living from forestry, that the Government and Coillte, the State forestry company that should be responsible for being the guardian of the people’s forest estate and enhancing the afforestation programme is, instead, facilitating profiteering by vulture funds from the UK in this case but potentially by all sorts of vulture funds.

This is so bad because it will exacerbate an already dysfunctional and failed forestry model. Gresham House and other equity funds do not care about biodiversity, farmers, rural communities, climate mitigation, soil or water quality; they care about making money. We will get more of these monocultural Sitka spruce plantations, which actually damage our environment, and adversely affect farmers and our aims to develop a sustainable afforestation programme. Will the Government agree to abandon this and to radically reform the mandate of Coillte in order that it starts to act in the interests of all of the people and stops facilitating the profit hunger of vulture and equity funds?

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy for raising this important issue, which I acknowledge is causing a lot of concern at the moment. We should not lose sight of the objective. The objective is to increase dramatically the amount of trees on our island and the amount of our land that is under forestry. We want an increase from about 11% of our land being forestry to something more like 18%, and that means planting millions of trees. We need trees for all sorts of different reasons. We need trees for timber, which includes spruce and conifer trees that are suitable for timber, so that we can build houses to help us with the housing crisis. We need other types of trees too, such as native woodland, for example, for climate action, biodiversity and leisure. It is intended to have a different mix of types of plantations for exactly that reason, namely, that we need trees for lots of different reasons. We need timber for desperately-needed homes, as well as trees for biodiversity and for leisure. All new Coillte forests will be open to the public.

We believe farmers will be the primary drivers of our afforestation programme, as well as being the primary beneficiaries of what is an ambitious forestry programme worth €1.3 billion. Farmers are Ireland's main landowners and will have the opportunity to play the most important and significant role in the creation of new forests. We have designed a new forestry programme to be as attractive to farmers as possible, with farmers receiving 33% more premium payments than other landowners under the new forestry programme, in addition to the single farm payment which other landowners will not receive. In many cases, the income farmers will derive from forestry will be tax-free. It is a very attractive offering and we are encouraging farmers to take up forestry on at least part of their land.

Regarding the Irish Strategic Forestry Fund, which the Deputy mentioned, there has been some misinformation regarding it. First of all, no public land will be privatised. The land that will be bought is already in private ownership. Most of it is already under forest and some bare land will be purchased and afforested. The Government is part of the fund. The Ireland Strategic Investment Fund, ISIF, the Government's sovereign welfare fund, is a minority investor in this fund, alongside the UK fund. Land that is now entirely in private ownership will be brought, at least in part, into public ownership, albeit through a minority shareholding in that fund. The total amount of forestry we are talking about is roughly 1% of all new forest that we intend to develop between now and 2050.

I want to be clear on this. Contracts have been signed. This was not approved by Government but contracts have been signed on it. To be clear, this is not our intended or preferred main model for increasing the number of forests in Ireland. Primarily, we want Irish farmers taking up the forestry programme and schemes that are now available. That will be the mainstay of our forest programme, not arrangements such as this.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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Pretty much every farmers' organisation, every organisation that represents communities in rural Ireland and every environmental organisation I can think of are utterly opposed to this deal. They say, rightly, that it is likely to drive up the price of agricultural land, squeezing out farmers and making it more difficult for them to engage in sustainable afforestation.

As I said, it will exacerbate an already utterly failed and dysfunctional model that has been pursued by Coillte, with the consequence that the vast majority of our public forest estates are dead zones of Sitka single species monocultural plantations that do nothing for biodiversity. Some reports have said they are actually carbon emitters because the trees are cut down too young. We need the State forestry company to stop facilitating the profit hunger of even more people by bringing in these funds and to instead support farmers, local communities, environmentalists and so on in developing a sustainable forestry model that will advance afforestation in a way that is good for climate, farmers and communities. This is not it. It is a corporate heist being facilitated with public money and by the State forestry company.

Leo Varadkar (Dublin West, Fine Gael)
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As I mentioned, this arrangement will account for roughly 1.5% of new forests developed between now and 2050.

The mainstay of the forestry programme is going to be Irish farmers and we are encouraging them to plant at least some of their land. The new forestry programme has been designed to incentivise farmers to the greatest extent possible, as I mentioned earlier. Under the new programme, farmers will receive 20 years of premium payments compared with 15 years for non-farmers. They will receive 33% more premium payments and farmers who want to plant new forests will receive the single farm payment on land that they convert to forestry. Private landowners will not receive that payment. As much of the income that farmers derive from forestry will be tax free, it is a very beneficial scheme in that regard.

I reiterate that Coillte will not be selling any existing publicly-owned forests to the fund and nor will it seek to purchase any other publicly-owned land on behalf of the fund. This is land that is already in private ownership that will be bought by a fund which has State involvement in the form of the ISIF.

Noel Grealish (Galway West, Independent)
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There has been a lot of debate in recent times about the state of our health services, with growing waiting lists, emergency department overcrowding and more. What may be missed in the middle of all of this talk is by how much services in the western and north-western part of Ireland lag behind those in the rest of the country. A capacity review carried out by the Saolta University Health Care Group in 2019 found that almost two thirds, or 64%, of the infrastructure at the region's biggest hospital, University Hospital Galway, UHG, was classified as either not satisfactory or unacceptable. In the case of its sister hospital at Merlin Park in the city, the figure increased to a shocking 95%. During 2022, waiting lists for inpatient and outpatient pain relief treatment in Galway increased by 75%, while the rest of the country only saw a tiny increase of just 1% in such waiting lists. The numbers in Galway waiting for 18 months or more, many in severe pain, are now more than three times greater than this time last year, while the rates in the rest of the country dropped by almost one fifth. In specialties such as orthopaedics, the experience of the patients in Galway falls well short of what is happening in the rest of the country.

The west of Ireland currently has the lowest survival rate in Ireland for breast and lung cancer. This is in a country that had the highest rates of cancer in the EU 27 in 2020. Experts in the field point out that late diagnosis leads to poorer patient outcomes. The facilities for the treatment of cancer in Galway are not fit for purpose. Cancer patients are competing with elective and emergency patients for vital life-saving treatment. I welcome the recent announcement that a new cancer care centre at UHG is to be included in the HSE's national service plan this year. I want to compliment Professor Michael Kerin for his excellent work on this project and I hope it will be progressed as a matter of urgency. We need similarly urgent action to be taken in relation to the rest of the health services in Galway and the west. At the very least, we must bring them up to a standard that is fit for purpose. The west is starved of proper services and I am calling for a task force to look at what is going wrong with the health services in the region and what needs to be done to improve them.

The Taoiseach may point out that a new elective hospital is to be built on the grounds of Merlin Park University Hospital in Galway but how long will it take for that to become a reality? Realistically, it could take 15 years or more, given that the recently-opened radiotherapy unit in Galway took over 14 years to deliver. There are many instances in the provision of health services where Galway and the west are falling well behind the rest of the country. What are the Government's plans to improve the delivery of healthcare to the people of Galway and the west of Ireland to bring it up to an acceptable standard? Will the Taoiseach ensure that proper resources are put in place?

Leo Varadkar (Dublin West, Fine Gael)
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Gabhaim buíochas leis an Teachta as ucht a chuid ceisteanna.

Ar dtús ba mhaith liom buíochas a ghabhadh lenár bhfoireann sláinte go léir as ucht an cúram atá á sholáthar acu inár ospidéil agus sa phobal le linn tréimhse an-ghnóthach. Sin é an fáth go bhfuil líon na leapacha ospidéil á mhéadú againn; tá an buiséid sláinte is mó riamh againn; agus tá níos mó dochtúirí, altraí agus foireann cabhrach ag obair inár ospidéil in iarthar na Gaillimhe agus i ngach cuid den tír. I agree with the Deputy on one important point, which is that we need to invest in our health services all over the country but also in the west of Ireland.

I share his frustration that so many important projects in the west have been delayed, particularly the emergency department and the paediatric and maternity units at University Hospital Galway, UHG, which should have been under construction by now, let alone have gone to planning. That is something I will be pursuing with the Minister for Health, Deputy Stephen Donnelly, and the Minister for Public Expenditure and Reform, Deputy Donohoe, over the course of the year so that we get those projects up and running. I am aware, of course, that there are other important projects that need to be advanced as well, such as the medical assessment units in Sligo and Castlebar and also the cancer centre the Deputy mentioned.

As Deputies will know, the Saolta University Health Care Group covers six hospitals in the west and north-west region and serves a very significant population, covering more than 830,000 people. We need to plan for a population of 1 million in that region in the course of the next 20 years. That is the way we should see it, not as a number of counties or cities but also as a region of 1 million people that should have the kind of health services and specialist services it deserves. The combined budget for the hospital group is more than €1 billion and that is an increase of 24% in five years. I recognise the importance of investment and we are committed to working with the HSE, the hospital group and individual hospitals to make sure that happens.

As regards cancer services, cancer survival rates have increased significantly in the past two decades in Ireland and continue to improve, as we know from the national healthcare quality reporting system. When it comes to lung cancer, which is the leading cause of cancer death in men and women in Ireland, our five-year survival rates are now above the OECD average, and the same goes for breast canner. In the HSE west area, the survival rate for lung cancer is 16.5%, compared with 17.1% nationally, a gap of 0.6%. The survival rate for the HSE west region for breast cancer is 82.5%, compared with 82.9% nationally, a gap of 0.4%. It is important to say there are many factors, not just one, that may give rise to this discrepancy.

As regards the elective hospitals we are building as part of the Sláintecare reform plans, we are committed to them but we are realistic that it will be 2027 or 2028 before patients will be seen in those hospitals and we need interim measures. That is why we are working on the surgical hubs, for example, which will help to bring down wait times in the meantime.

Noel Grealish (Galway West, Independent)
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I thank the Taoiseach but, given the track record of the HSE, I cannot see that happening. I appreciate there has been some investment and there are plans for further investment in health services in Galway and the west but the region is still lagging behind the rest of the country and needs much more. I have raised previously the need for a minor injuries unit in Galway. I visited the excellent facility in Roscommon and I was extremely impressed with the efficient way in which it deals with everything from broken bones, lacerations, sprains and strains to minor scalds and burns. There are 15 of these minor injuries units across the country, helping to relieve the pressure on busy hospital emergency departments, but there is none in Galway. The emergency department at UHG remains one of the busiest in the country, without the relief that would be provided by thousands of people being redirected to a minor injuries unit. Can the Taoiseach give a commitment that a minor injury units will be built in Galway to help to alleviate the pressure on UHG?

Leo Varadkar (Dublin West, Fine Gael)
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Almost all regions of the country would say they are underfunded or under-resourced when it comes to healthcare. The Deputy has made the case very strongly today for the west. I have heard Deputy Shanahan, who is sitting beside him, make the same case for the south east on many occasions and many of my colleagues have made the same case to me in respect of the mid west only a few weeks ago. Where the truth lies and where the balance of resources and funding is located is quite opaque. That is one of the reasons we need to move towards population-based funding in healthcare and that is very much part of the Government's reform programme. I have seen minor injury units work extremely well across the country. I cannot give the Deputy a commitment here that we are going to do what he says but I think they make a big difference and I have seen them work extremely well in all parts of the country, with people with minor injuries not having to go to very busy and crowded emergency departments and, more important, people with minor injuries who need to be seen and to receive healthcare getting that healthcare in an uncrowded and more humane setting within a few hours. We are happy to give consideration to a minor injury unit for Galway but I am not at liberty to make that commitment here and now. We will certainly take it seriously, however.