Mary Lou McDonald (Dublin Central, Sinn Fein)
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I want to read to the Taoiseach a letter from Nikita Clarke, who is from Dublin and who I met recently. She suffers from suspected endometriosis:

Thank you for taking time out of your day to read this letter. Please listen carefully, this is not easy to talk or write about. I am 18-years-old and instead of getting my driver's licence, picking out a Debs dress, studying for my leaving cert, going out with friends or getting a job, I spend my days sitting bed in horrific amounts of pain. My days just roll in all together. I barely get any sleep because of pain. Everything I do isn't without a high level of pain. Walking hurts. I have to use a walker and a wheelchair to get around. I need help getting dressed, having a shower, doing my hair, going to the toilet. It's humiliating. Being a young woman once full of hopes and dreams, now completely numb. I don't allow myself to feel because if I do, I won't be able to stop. I have to watch my friends move on with life, going to parties, graduating, getting their licences and so much more, while I hate weekends because it means a doctor won't call to set up my surgery. How sad. An 18-year-old who hates weekends. I need the surgery to see if I have endometriosis. It has been three and half years. I have been patient. I have done everything the doctor told me to do. I am fully dependent on my mam. I get headaches that blur my vision. I have pain peeing, stomach pain. I’ve had bleeding constantly with breaks only of a few days. How am I meant to stay happy and hopeful when no one is listening to me or helping. I once dreamt of being a lawyer, a doctor or nurse, having a family of my own. Now, I am a young woman alive but not living. Please help me live again.

Endometriosis is a crisis in women's health. It is a chronic, inflammatory and whole-body disease that affects the pelvic region, uterus, fallopian tubes and cervix. It effects one in ten women in Ireland and yet it takes nine years for a woman to get a diagnosis here. Often, by the time an endometriosis diagnosis is received, the disease has spread beyond the reproductive system. It can travel to the bladder, bowels, diaphragm and even the lungs. Instead of receiving excision surgery here in Ireland, many women and girls are forced to travel abroad to have the specialised surgery and to receive an official diagnosis. The lack of understanding and awareness often sees the suffering of women and girls dismissed, their pain often put down to bad periods. Instead of getting proper care, they receive outdated treatment that prolongs pain and trauma.

Tá géarchéim inmheatróise i gcúram sláinte na mban in Éirinn. Cuirtear iachall ar mhná diagnóis agus cúram a lorg thar lear. Bíonn ar a lán ban fulaingt go ciúin. Caithfidh an Rialtas gníomhú chun deireadh a chur leis an gcrá croí seo.

This scandal has impacted thousands of women, with very few families left unaffected and it has gone on for far too long. Will the Taoiseach commit to delivering a long overdue specialised centre for the treatment of endometriosis, and will he ensure the provision of excision surgery in Ireland is available so women are not forced to seek care abroad?

Deputies:

Hear, hear.

Micheál Martin (Cork South-Central, Fianna Fail)
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First, I thank Deputy McDonald for raising the issue and for reading out Nikita's letter to her, which clearly illustrates the very debilitating impact endometriosis can have on women. It is extremely debilitating, painful and the span of impacts are very wide. Regarding a phased response, this can be at GP, gynaecology or indeed specialist centre level.

There has been progress for endometriosis. Approximately €5 million in additional funding has been spent and €2.1 million has been allocated for this year. If it is allowable, I ask Deputy McDonald to forward the correspondence to us because Nikita mentioned it has been three and half years. We have two supra-regional hubs established in Tallaght and Cork, with the latter opened recently. The estimates are saying, and they are conservative estimates, that there are 350 severe cases - and Nikita is clearly in the severe category - per year that will require a referral to the specialist endometriosis clinics and services that are located in Tallaght and Cork. In addition to those, there are five other hubs across the country in the Rotunda, the Coombe, the National Maternity Hospital, University Hospital Limerick and University Hospital Galway. There were approximately 760 women on a specific waiting list for treatment at the end of last year and the agenda is to get through the backlog as quick as possible. There are discussions under way and hopefully the national framework in respect of endometriosis will be concluded but there is engagement with GPs and between GPs and the HSE regarding the precise role of primary care versus gynaecological care and then obviously the specialist hubs.

As the Deputy said, one in ten women will have this condition. There is the development of a national endometriosis framework and the Minister is keen to bring this to a conclusion. This was discussed in the House previously and all questions have been asked in respect of that. The model of care has been outlined and there is a clear framework there. Investment is happening and will continue. This is on top of significant investment in women's health in recent years which has been quite transformative compared to what was there before. There has been specific investment into a whole range of areas pertaining to women's health. This is one area that needs further investment but it also needs the national framework to be concluded.

The two supra-regional hubs are there for the specialist and severe cases and the referral should be sent there in the context of Nikita's letter, although I do not have the full background to it. We fully acknowledge it is a very real issue for women involving very severe pain that impacts on one's personal and working life. It is something Government is very committed to addressing.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Nikita is 18-years-old. I am more than happy to forward the correspondence to the Taoiseach and the Minister. Nikita will travel to Romania to get the care she requires. Despite the assertions in his response, the fact is that the level of care here is simply unacceptable.

Pearse Doherty (Donegal, Sinn Fein)
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Hear, hear.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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I know of a woman who lost a kidney to endometriosis. I know a 27-year-old who went through a radical hysterectomy because the disease, in her case, had eaten away at her pelvic organs and bowel. The services are not available to women and there should not be any attempt to dismiss or downplay the real experiences of women and girls.

They are asking now for proper investment. Have a framework by all means but we need a specialised centre that offers the care that is required.

Experts have been telling the Government for a decade that excision surgeries are the only way to go.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I thank the Deputy.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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The Government knows this. Yet, that treatment and service are not available.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I ask the Deputy to conclude.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Why is the Government instead offering treatments that the experts have told it will fall short and will fail? I appeal to the Taoiseach to listen to the voice of this young woman and those of the other women whose lives have been devastated by the failure to provide them with the care they need here in Ireland.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I thank Deputy McDonald.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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So many of them are now travelling. That is the most damning evidence of the Government's failure.

Micheál Martin (Cork South-Central, Fianna Fail)
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There has been significant progress in this area. That has to be acknowledged. More than 200 new patients were seen in Cork's endometriosis service from May to December last year. About 94% of women on the waiting list in that region are now seen within six months. As I said, more generally we are seeing improvement in terms of the Tallaght centre also. The Government is listening. In terms of the State, the Government, the HSE and everybody involved in this area have been engaging to get the national framework concluded so that there will be a comprehensive range of services covering the entire span of symptoms or manifestation of the condition, in other words, from primary care to the hubs to the super-regional hubs. Specifically, specialist care is available. There is ongoing recruitment. Additional posts are being recruited as we speak, specifically for this area. Admhaím go bhfuil géarghá le níos mó infheistíochta. Tá sé sin á chur ar fáil againn faoi láthair. Is é sin an aidhm atá againn.

When we look at all the other developments in women's health over the past two to three years, it is clear we can and will do this. There have been some very significant developments. I am not going to list them all but they are there. In terms of endometriosis, it will be manifest as well. It already is in that two super-regional hubs and the five other hubs are there.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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I do not know who the Taoiseach is listening to.

Micheál Martin (Cork South-Central, Fianna Fail)
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It is important to get the framework.

Ivana Bacik (Dublin Bay South, Labour)
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There were 233 children on a waiting list for spinal surgery at Children’s Health Ireland, CHI, hospitals at the end of February. Of those children, 43 who had been approved for surgery had been waiting more than six months and 15 of those had been kept waiting for more than a year. These children are in agony. It is a national shame on us all that they are kept waiting so long. This morning, "The Oliver Callan Show" radio programme heard from Louise and Alannah Collins, mother and sister to 14-year-old Daniel Collins from Tralee. Daniel has severe scoliosis. In the 14 months since he was told he needed surgery, his surgeon in Crumlin has not been able to offer him a single date. His back initially had a curve of 22 degrees. There is now a 95% curvature to his spine so he will need two surgeries and has no date for either of them. Advocating for Daniel on the airwaves is not something that Louise or Alannah should have to do. They painted a heartbreaking picture of the real-life impact of dysfunction in the health service.

The thought of a child in pain is appalling. Persistent pain or worsening health are the last things any of us want for our own children or for anyone’s child. We all know Children’s Health Ireland has important work to do to ensure the protection of children's health. It is tasked with ensuring our children receive the highest standards of care when they are sick. It is also overseeing the movement of three hospitals onto the new campus at St. James’s Hospital. We will now be wondering whether Children’s Health Ireland will ever fulfil its commitment to provide surgery to children like Daniel within four months. The publication of this latest HIQA report on spinal surgeries compounds these fears. The resignation of the board’s chair, Dr. Jim Browne, yesterday only further confirms the doubts and concerns. It reports so-called experimental spinal surgeries and unnecessary surgeries. We know about the lengthening waiting lists and doubts about so many aspects of the move to the national children’s hospital. Some commentators are suggesting since yesterday that problems at CHI start and end with the actions of one rogue surgeon. However, while the details of reckless experimentation are horrifying, clearly the problems at CHI go deeper than that.

The HIQA report is deeply concerning in indicating systemic failures at a broader level. With more reports to come, what is obvious now is that there is a dysfunctional culture and that trust must be restored. It is difficult for parents to hand children over to an institution that has been criticised, as CHI has been by HIQA. With this damning report, and more to come, it is hard to see trust being restored without robust action. Looking at how that robust action may now be taken, I ask, first, whether the Government will examine the model used following the cervical check scandal and how trust was rebuilt there? I am thinking of the important work of the 221+ Group, for example. Second, can the Taoiseach say whether the board of CHI now retains his confidence and that of the Minister for Health? I am thinking of all those families impacted by the use of corrosive springs, families waiting on a surgery date and of course thousands of children waiting for the opening of a world-class children’s hospital who are awaiting the Taoiseach's response on this.

Micheál Martin (Cork South-Central, Fianna Fail)
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There are a number of issues there and I thank the Deputy for raising them. I fully understand the trauma that the family of Daniel Collins is going through in respect of the delay in getting surgery carried out. I do not want to go into the background of every individual case in terms of complexity of the case and so forth. My understanding is that there has been engagement. The assistant director of nursing lead for the spinal surgery management unit spoke with Daniel's family on 2 April and discussed his plan of care. There was a further engagement on 7 April. I hope that his case can be progressed. As I said yesterday, it is now in the hands of the clinical team managing his case. A multidisciplinary team meeting will be held in respect of Daniel's case in terms of assessing and dealing with the issue. It is a matter for the multidisciplinary team to come forward with that and engage with the family in respect of timings and so forth.

In terms of the broader issue, there has been far greater activity in spinal surgery within CHI. That has to be said. There has been a reduction in waiting times and in the lists. Others have come forward. It is not where it should be. We are going to continue to press ahead. The Minister is very focused on the issue, to further reduce waiting times for scoliosis surgery and spinal surgeries more generally and also to increase activity levels there.

We are awaiting further reports to be presented to the Minister. HIQA is the external independent body to ensure quality within healthcare settings in Ireland. It has produced a report in respect of the specific issue of the use of springs, which is absolutely unacceptable. We are all agreed on that. Then there are issues regarding the independent review being led by Mr. Nayagam. There are two parts to that, namely, the review in terms of the individual risk and then the independent review in terms of assessing the governance of paediatric orthopaedic surgery service to make findings on improvement in governance, quality, safety outcomes and performance metrics.

Meanwhile, the work has to continue in CHI. A new CEO has been appointed to CHI. The chairperson has resigned. A new chairperson needs to be appointed. The board needs to do that. Some have called for the board to be disbanded. That would not help the situation right now in any shape or form. It would weaken governance even further and could lead to further difficulties and challenges.

Ivana Bacik (Dublin Bay South, Labour)
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I thank the Taoiseach for clarifying that there has been engagement with Daniel Collins's family. However, I understand there is still no surgery date. We all wish Daniel and his family well. However, the reality is there are far too many families and far too many children still awaiting necessary surgery dates. Quite apart from the trauma all those families and children are going through, there is a broader issue. Our health spokesperson, Deputy Marie Sherlock, pointed out the broader issue of systemic failure highlighted by this HIQA report.

To return to that issue of confidence, there are three fundamental questions.

Is the Taoiseach confident that the board is capable of implementing the HIQA recommendations and can guarantee the provision of safe surgeries for children who need them? Can this board manage this complex transition to the new world-class children's hospital that we all so fervently hope will be available and accessible soon to the children across Ireland who need it?

Micheál Martin (Cork South-Central, Fianna Fail)
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Nobody is happy with this. I am certainly not happy with it and I know the Minister is not happy with it. The Minister is meeting with the board and the HSE regarding these issues. The two further reports, one of which is about dysplasia, need to come in. The three reports will be assessed in totality. We need - over time because we do not want to create any further disruption - to get to the bottom of this, and we will with these reports. The report about spinal surgery has been very clear and transparent about what happened and has outlined what happened. We now need to keep the focus on getting more activity within in the hospital. A lot of good work has been done within the hospital. That needs to be said. Many of the consultants have done very good work and have co-operated. We have significantly improved the level of activity in this area in terms of scoliosis in particular and spinal surgery more generally. In the medium to longer term, we need to look at the overall structures governing paediatric care. That is a point I would make and we need to reflect on and consider that.

Cian O'Callaghan (Dublin Bay North, Social Democrats)
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Medical experiments were conducted on children in our major paediatric hospital. Corrosive springs were inserted into the bodies of extremely vulnerable children. No ethical approval was sought for the use of the springs and the families did not give informed consent for these procedures. This was not an isolated incident. The litany of failures raises serious questions about whether Children's Health Ireland is fit for purpose.

Despite this, yesterday in this Chamber, the Taoiseach ruled out a public inquiry into the enormous governance failures at Children's Health Ireland. The Taoiseach said previously that all the recommendations of the HIQA report will be implemented but families have heard that before. In 2013, a report into services for children with spina bifida found major deficits and a lack of co-ordination at national and local level. The recommendations from that report were not implemented. In 2017, a damning report from the Ombudsman for Children found serious and ongoing violations of the rights of children waiting for scoliosis treatment. In response, the then Minister for Health, Deputy Simon Harris, promised that no child with scoliosis would wait longer than four months for surgery. That promise was never kept. In 2023, the Ombudsman for Children published the Ivy report into the care of a child with scoliosis by Children's Health Ireland. That report found numerous failures of governance and communication within Children's Health Ireland. In 2024, a follow-up report to the Ivy report revealed that surgery was delayed for Ivy for so long that she was no longer operable. The latest damning report into Children's Health Ireland cannot be viewed in isolation. In fact, we know that two more reports into care at Children's Health Ireland are on the way, one of which will detail that potentially hundreds of children had unnecessary hip surgeries. Can one imagine the devastation felt by parents upon learning that their child has been put through traumatic surgery that was never needed?

The extent of the crisis at Children's Health Ireland and its implications for the care of children in Ireland are enormous. Last night, Úna Keightley from the Spina Bifida and Hydrocephalus Paediatric Advocacy Group said she had written to the Minister for Health three weeks ago but had yet to receive a response. Will the Minister meet with Úna Keightley and advocacy groups? Given the crisis at Children's Health Ireland, does the Taoiseach believe that ruling out a public inquiry into this scandal was too rash?

Micheál Martin (Cork South-Central, Fianna Fail)
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A lot of progress has been made and that does not get acknowledged. The HIQA report is a good report insofar as it clearly lays out what happened. What happened was wrong. It was incomprehensible. I said that yesterday. It is beyond belief that one would insert devices into a child that are not CE approved. It is very hard to comprehend that. That is unacceptable.

In terms of spinal procedures more generally, we are increasing activity year on year. There has been a 35% increase in activity compared to 2019 but we need to do more and that means recruiting more qualified surgeons and entire teams to enable that level of activity to increase. There has been a decrease of close to 20% in the number of those waiting over four months and a 59% reduction, as it should be, in the number of those waiting over 12 months but it is not enough in itself. We set up the dedicated paediatric spinal surgery management unit in 2024. There is a ring-fenced theatre in Crumlin. A lot of things have happened to enable a greater throughput and more consistency in terms of getting surgery done.

I spoke about public inquiries during Questions to the Taoiseach yesterday. Up to five public inquiries are being sought on different matters. I told the entire Dáil that we need to reflect on that. Is it the best model to investigate issues of this kind? Public inquiries are costing millions. Since 1998, €500 million has been spent on inquiries. There is an ethical question as to whether resources should be targeted at existing services for children living today across social, healthcare and education services. Inevitably, victims who seek inquiries do not get closure from them and are not happy with the outcome of inquiries. Many of these inquiries are taking years and costing millions. This is a serious issue. I have been in opposition so I am not casting aspersions on anybody but the easiest thing to do is to call for a public inquiry. It is a case of "that's done, we've called for it, so let's have it". Judges are taken from courts, reluctantly now because very few judges are coming forward. As an Oireachtas, we need to examine this.

My view is that we have agencies we have statutorily established to investigate issues. That is what HIQA is for in terms of healthcare. That is why it was set up. The Health and Safety Authority was set up for accidents while Fiosrú, which was GSOC, was set up for An Garda Síochána. These agencies need to do their jobs effectively and properly. I am not sure whether having public inquiries or calling for public inquiries or commissions of investigation that go on forever, cost millions and where people are not happy at the end of them is a sustainable model.

Cian O'Callaghan (Dublin Bay North, Social Democrats)
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Government has a role here when report after report shows that recommendations are not being implemented. Government has a role to ensure that those recommendations are implemented. If that had happened in this case, we would not be in this situation. If the Government will not set up a public inquiry into the cases of the families affected, who are calling for that, what is it going to do to sort this out? I asked the Taoiseach whether the Minister will meet with the families affected, as they have requested. Could the Taoiseach answer that question? I agree that the surgeon bears huge responsibility in terms of their unacceptable actions but in terms of the wider issues, it is the families who are saying that there is a gaping hole in governance at Children's Health Ireland. They have been ringing alarm bells about this for years and feel they have not been listened to. If they had been listened to, we would not be in this situation. What will the Government do to sort this out?

Micheál Martin (Cork South-Central, Fianna Fail)
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First, we will implement the recommendations of the HIQA report. Second, there is a task force on the broader issue of paediatric spinal surgery headed by Mark Connaughton with which the Minister will meet tomorrow. In terms of governance issues, we will engage with those from now on. Instead of waiting for further investigations we will proactively look at the structures and governance framework there and respond to that. We all know that the big issue in paediatric medicine more generally is the transition from the existing hospitals to the new children's hospital. This will be the big issue. Whatever we do, and we have to implement all the recommendations, absolute focus must be on that transition to ensure it is as optimal as possible in terms of resourcing and staffing the hospital. It will be transformative, even in terms of the physical conditions at Crumlin and Temple Street hospitals compared to those at the new hospital.

Cian O'Callaghan (Dublin Bay North, Social Democrats)
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Will the Minister meet them?

Micheál Martin (Cork South-Central, Fianna Fail)
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We will meet and the Minister is open to meeting and engaging with the advocacy group. We would like to work through these issues with the advocacy groups and give our perspective as to what would lead to more immediate and quicker results that everybody wants in relation to all the issues the Deputy outlined in the question.

Brian Stanley (Laois, Independent)
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I raise the child disability network teams and the chronic situation regarding their staffing. There are vacancies across the State. They run between 22% and 29% according to replies I have received from the HSE. In County Laois, however, the situation is far worse. I will read the figures for the shortages: occupational therapy in network 12, which covers most of the county, is 33% staffed; speech and language therapy is 46% staffed; physiotherapy is 50% staffed; therapy assistants and dietetics are zero staffed. In network 11, which covers the north of the county and part of Offaly, the situation with dietetics is the very same. Therapy assistants and behaviour therapists both have zero staffing. For families with children on the autism spectrum, or with ADHD, dyspraxia or similar conditions, trying to get an assessment is a problem but trying to get the therapies is a bigger problem. This has to be sorted. The programme for Government says on page 92 that the Government will “increase staffing, train more therapists and prioritise children’s disability teams”. I welcome that commitment but the Taoiseach has been in government for most of the last 30 years. The Taoiseach was Minister for Health at one stage and I have to bring it to his attention that right through that period, this crisis has pertained. I remember during the boom of the Celtic tiger, parents coming to me as a county councillor who were desperately trying to get services. It goes back to that boom in the late nineties. Then we had the crash and then the uplift in 2014 and 2015 and we are still in the same situation. This has to be sorted out. Children are missing out at crucial periods in their development. We know, as does the Taoiseach and everyone who looks at these issues, that early intervention is key, but it is not happening. This is putting enormous pressure on parents and families. They are coming to TDs and when they have to come to TDs, councillors or anyone else, the system is failing and we must address it.

Some voluntary organisations such as Laois Offaly Families for Autism are trying to plug that gap by providing therapy and assessments but they can only do so much because they are voluntary organisations. As an Oireachtas, we have a responsibility – the Opposition and the Government – to sort this out. We have to increase the pipeline of staff coming into the services. The programme for Government includes the commitment I have mentioned, but there are immediate actions that can be taken on that.

Micheál Martin (Cork South-Central, Fianna Fail)
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I thank the Deputy for raising this issue which is very serious. I would make the overall point, and I do not want to go into the history of provision, that there has been dramatic exponential growth in the level of investment and provision both on the education side, in terms of special needs, and on the health side. On the education side, it is much more clearly to be seen in the transformative impacts over 20-odd years with investment in special education. Back in the late nineties and early 2000s we had no special classes or special needs assistants. That only started in the late nineties. Over the past five years alone the number of pupils attending special classes has gone from 9,000 to 19,000. Those attending special schools have gone from 7,800 to 9,000. The number of special classes has doubled and there will be further increases in that.

That is on the education side. I accept fully the CDNT situation is not at all satisfactory and the absence of fully staffed multidisciplinary teams is a huge issue for CDNTs more generally. In the 2022 census, about 13% of children were identified as having a disability. Huge money has been allocated on both sides but people are not interested and rightly so because people are interested in a service for their child and they are not getting access to therapists in particular. Recruitment is under way. There is an issue with the assessment of need which the Government is examining. That is drawing down a lot of resources following that High Court decision which means an awful lot more is going into the assessment and not the delivery of services. Our Government will bring forward legislation on that. It will be challenging - I have no doubt it will be debated in this House – but that nettle has to be grasped because it has to be dealt with in order to have a more efficient and effective assessment of need and to make sure that from day one, children get the services they require. Second, recruitment continues. There had been issues in the HSE around the recruitment of therapists. Those were not funding issues but recruitment and retention issues. The vacancy rate was as high as 29% in 2023. That has come down to 21%. The posts are approved and funded but the recruitment issue has been a factor. The CDNT workforce has grown by about 17%, with an additional 272 posts having been filled, but it is still nowhere near optimal. That is why we have decided as a Government to pursue a therapy in education approach, particularly for special schools - we want them to be in a position to have multidisciplinary teams separate from the health service itself for the children with the most profound special needs.

Brian Stanley (Laois, Independent)
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I thank the Taoiseach for his reply. Yes, the education situation has improved over the last two and a half decades. I accept that. We have more to do there but we were starting from zero where we had nothing. However, in the HSE overall, there is a great problem between budget and services. No one will dispute that a considerable budget is going in. Certainly, I will not argue with it. There is a problem at the other end when we see what comes out in terms of services. There is a fog in the middle. Where does the money go? There is a question mark around that. It is the same with these therapies.

When the Minister for Finance was deputising for the Taoiseach here a few weeks ago, he told me that the Taoiseach was chairing a Cabinet subcommittee on this. I would say three small things to the Taoiseach. First, he needs to expand the number of training courses in speech and language therapy, occupational therapy, physiotherapy, psychology and therapy assistants and dietetics. Second, he needs to recruit people for full-time positions and retain them in the services. Third, the Taoiseach mentioned the gaps in services. The gap is 100% in those therapies in networks 11 and 12. Someone needs to look at this. This should not be the case. There are no services in some of those therapies in Laois.

Micheál Martin (Cork South-Central, Fianna Fail)
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I do not disagree with the Deputy at all. I agree with him that there is an issue with the budget going in and the services coming out. That needs to be constantly interrogated. There is no question about that. I am chairing a Cabinet subcommittee meeting on disability and we are establishing a disability unit in the Department of An Taoiseach to work hands-on with all the various Departments and get a co-ordinated approach in every single Department towards the disability issue.

On therapists, in July 2024 funding was provided to boost training places in speech and language therapy, occupational therapy and physiotherapy. This will lead to a 35% increase in student places this September. New student places were launched in September in Galway in speech and language therapy, occupational therapy and podiatry. We have instructed the Minister for higher education to go back to the universities for the next academic year to have a substantial increase in the number of places for therapists but that must be followed and paralleled with an increase in clinical training places for them. We are also engaging with CORU about registering qualified people from overseas much more quickly than is currently the case.