Dáil debates
Tuesday, 20 May 2025
Ceisteanna ó Cheannairí - Leaders' Questions
2:00 am
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I extend a céad míle fáilte to the students of Coláiste Eoghain from Buncrana and to the women from the Breaffy walking group in Castlebar. They are all very welcome.
At 10 o'clock this morning, Cara Darmody, a 14-year-old disability campaigner, began a 50-hour protest outside the Dáil and she joins us in the Gallery as well. I extend a very warm welcome to her and to her father, Mark. Cara is an exceptional and amazing young woman who has stepped forward to fight not just for her brothers Neil and John but for all of the children so badly failed by Fianna Fáil and Fine Gael Governments. At the heart of Cara's protest is one simple demand, namely, that the Government comply with the law and ensure no child is left behind. Children with disabilities are legally entitled to an assessment of needs within six months and yet 15,296 children are left well beyond this timeframe, some for years, delaying their access to vital therapies and appropriate school places. The HSE anticipates that this dire situation will get worse. By the end of 2025, there could be almost 25,000 on waiting lists for assessment of needs.
I have been contacted by so many parents over the last week and they all have the same story. One mother got a letter on Friday to acknowledge her application for assessment of needs and was informed that the waiting list is in excess of three years. Another told me her son is on the list for an appointment which has been cancelled over and over again. Another parent's daughter got a letter saying it will be between 24 and 33 months before she will be seen, and this child is already on the list for over a year. I work with parents every day in my own constituency. In the north-inner city, the waiting lists would make your eyes water and it is even worse in Cabra. Even when you get your assessment of needs, the fight continues for therapies, school places and very basic services.
The Government has broken the law over and over again. There is a legal requirement on the Government to provide an assessment of needs within six months and it has broken this over and over again. Children are being failed dramatically, left in limbo while they wait for the supports to which they are entitled. How is it that children are so badly failed? Why is it that people with disabilities are so badly failed? There is no indication from the Government that it is serious at all about complying with the law. Today, the combined Opposition comes together and demands that the Government comply with the law. Our motion tonight lays out the clear, concrete steps needed if the Government is serious about tackling assessment of needs waiting lists and complying with its legal and moral obligations.
Tá an dlí briste ag an Taoiseach arís is arís eile. Tá teip shuntasach á déanamh ar leanaí faoi mhíchumas atá fágtha idir dhá cheann na meá ag fanacht ar mheasúnaithe ar riachtanais ar a bhfuil siad i dteideal. Inniu, tháinig an Freasúra go léir le chéile chun iarraidh ar an Rialtas cloí leis an ndlí.
Can the Taoiseach tell parents clearly what the target date is by which the Government will comply with the law? Can he set out the emergency action he will take and the resources he will make available to Cara's fund to clear the current backlog? What about workforce planning, because in some parts of the State, 60% of positions within the children's disability network teams, CDNTs, are currently vacant?
2:05 am
Micheál Martin (Cork South-Central, Fianna Fail)
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At the outset, I appreciate the work Cara Darmody has been doing and her campaigning work with her father, Mark. She has been campaigning for quite some time. She initially began to do so in terms of advocacy for her family and now does so nationally in respect of disability rights more generally.
When I was appointed Taoiseach earlier in the year, I committed that this would be a Government that would make a step change, comprehensively and across all areas of government, in provision for people with special needs or with disabilities, and with a particular focus on young people. The issue of disability is represented at the Cabinet table by a full Minister, and I am in the process of establishing the first ever disability unit within the Department of An Taoiseach to troubleshoot and co-ordinate across all Departments the provision of services for people with disabilities.
To go through the various areas, first, the need is increasing all the time. The 2022 census is indicative of that in terms of the increase in the numbers of people identifying with a special need. Fundamentally, in education, there has been an exponential increase in investment. There has been a major increase in resources in terms of special needs assistants, with approximately 23,400 of them now. There are 20,800 special education teachers. The expenditure on SNAs alone is approximately €1 billion per year and that is the way it should be. Enrolment in special classes has doubled in five years, with nearly 19,000 students being supported in 3,335 classes, and more than 2,700 new placements are planned for 2025-26.
A new national therapy service in education, beginning in special schools, has been agreed upon by Cabinet and work is under way to get that in place, partially in the next school year, 2025-26, and fully thereafter.
In terms of the National Council for Special Education, NCSE, 39 new therapist posts have been approved. That recruitment is well under way and has been quite successful and effective.
In regard to income supports, the Minister for Social Protection is working on specific budget provisions for children in particular, and people more generally, with disabilities.
On transport, we have specifically asked the Minister for Transport to work on the mobility issues. We are working with the Department of Finance to put the disabled tax scheme back on a proper footing, and on a better footing than was the case beforehand.
In respect of the assessment of need, quite fundamentally, we need to change the legislation. The High Court decision necessitates, in my view, a change in legislation to ensure therapists are directed and streamlined to provide services to children more quickly than is currently the case. We currently have a finite number of therapists in the country. The real objective has to be to use those therapists optimally in providing services to children. I say that very clearly because I am looking for solutions here and that is one nettle we have to grasp.
It will be challenging, but we still have a Cabinet subcommittee on disability and it has asked the Minister for children and the Department of children to come back with legislative proposals in respect of the assessment of need area. Recruiting and retaining therapists is very important, as is the mutual recognition of qualifications across Europe and with the United Kingdom to enable us to bring in more therapists from overseas in addition to those we will produce through our colleges.
Tá gach aon iarracht á dhéanamh ag an Rialtas chun déileáil leis an bhfadhb seo. Tá an-chuid áiseanna ann ach an rud is tábhachtaí ná go bhfuil gá ann an córas a athrú go tapa.
2:10 am
Mary Lou McDonald (Dublin Central, Sinn Fein)
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What the High Court found is that the State is breaking the law.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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What the High Court demanded is that the State be in compliance with the law.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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That is what the ruling means. It does not mean change the law. The Taoiseach's message to us today is that rather than working to be in compliance with the law to ensure that children get the assessments of need to which they are legally entitled within the statutory framework of six months, his idea is to change the law and remove that provision. There is a common view, certainly across those who work within the disability sector and with families, that the problem is not the law. It is actually a very good law. It is a good idea that a rigorous and thorough assessment of need is given to every child and person who needs it within a six-month timeframe. The issue here is Government inaction and Government failure.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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I put it to the Taoiseach again that rather than suggesting he simply changes the law, he should comply with the law and tell us how-----
Verona Murphy (Wexford, Independent)
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The Taoiseach to respond. The Deputy's time is up.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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-----he is going to make it possible that those 15,000 children, who wait and wait, will get their assessments of need and consequently the services and supports to which they are entitled.
Verona Murphy (Wexford, Independent)
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Maybe the Deputy could stay within her own time.
Micheál Martin (Cork South-Central, Fianna Fail)
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The Deputy has offered no solution. She has offered rhetoric, and that is all.
Mark WardMicheál Martin (Cork South-Central, Fianna Fail)
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The bottom line is this. We will do everything we simply can to deal with the existing waiting lists and so forth. There has been a significant increase in the numbers of assessments that have actually taken place - a 30% increase on 2023 - but that in itself will not deal with the current situation. We have to have a multifaceted response. We need more therapists in third level colleges.
Micheál Martin (Cork South-Central, Fianna Fail)
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We will be providing more private funding to procure assessments. All of that, however, will not, in my view, redirect the work of therapists most appropriately, which is to provide services to children.
Mary Lou McDonald (Dublin Central, Sinn Fein)
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You need an assessment of needs before you decide on a child's therapist.
Micheál Martin (Cork South-Central, Fianna Fail)
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I am making a point. Under the current system, the status quo is simply not tenable. The Deputy must know that deep down, so there has to be change in respect of that.
Pearse Doherty (Donegal, Sinn Fein)
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The Government is robbing the children of their assessments.
Louise O'Reilly (Dublin Fingal West, Sinn Fein)
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There has to be a change.
Micheál Martin (Cork South-Central, Fianna Fail)
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In my view, we have to explore every avenue we can to increase the number of therapists and to recruit more therapists. The money is there in many instances-----
Louise O'Reilly (Dublin Fingal West, Sinn Fein)
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The Taoiseach has failed those children.
Micheál Martin (Cork South-Central, Fianna Fail)
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-----and the HSE has not been able to recruit 100% of its CDNT teams.
Conor McGuinness (Waterford, Sinn Fein)
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It is utterly shameful.
Ivana Bacik (Dublin Bay South, Labour)
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Today, as the Taoiseach knows and as we all know, marks the beginning of the 50-hour protest by young Cara Darmody. Like others, I welcome Cara and her father Mark to the Gallery. Cara is an incredible campaigner for the rights of children with additional needs, and she is only 14 years old. She is staging this protest, as the Taoiseach knows, to raise awareness of what is an emergency, the Government's failure to comply with the Disability Act. The Taoiseach has just said in response that the status quo is "not tenable". Of course the status quo is not tenable. It is not tenable for children like Cara's brothers or for the many thousands of children, 15,000 children nationally, who are now languishing on waiting lists awaiting an assessment of need, in breach of the Government's own law.
When the HSE receives an application, it is set out in law that the assessment of need must be carried out within six months. My colleague Deputy Alan Kelly has received responses to parliamentary questions which reveal that in the first quarter of this year, that legally binding six-month deadline was missed in a shocking 93% of cases, which is an extraordinarily high rate of failure. It is a desperate embarrassment, and it is an ongoing problem that the Taoiseach has inherited from his own outgoing Government, the previous Government. There can be no passing of the buck. The Taoiseach said there would be a step change; he used that language again just now.
Micheál Martin (Cork South-Central, Fianna Fail)
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There will be.
Ivana Bacik (Dublin Bay South, Labour)
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That is not what we have seen.
It is two years to the week this week since we in Labour brought a Dáil motion, with the great support and encouragement of Cara Darmody, setting out a constructive plan to take on and address these waiting lists and to treat the chronic delay in diagnoses like the national emergency it is. Many of us will recall that on that day in this House, the then Minister of State, Anne Rabbitte, made a powerful speech acknowledging responsibility for failure and the profound impact on children and families.
Anne Rabbitte made a commitment that if capacity did not improve, she would adopt our Labour Party proposal to reimburse parents for private assessments as an emergency and as a constructive way of addressing this appalling shortfall. We all took that significant announcement as a sign that the Taoiseach and his Government would place a greater focus on resolving this. However, the stories and accounts we are hearing from parents and families throughout the country and the waiting list figures really say otherwise. We understand the Government will not oppose tonight's cross-party motion. That is welcome, but non-opposition is not enough. The Government did not oppose our Labour Party motion two years ago on this very topic. It made all the right noises then, but the problem has grown worse since then.
The responses to Deputy Kelly's parliamentary questions show that in the first quarter of this year, just 1,412 assessments were carried out. That is a tiny number, a fraction of the need, when we see that more than 15,000 children are overdue an assessment. This number is expected to grow to 25,000 by the end of this year. I am asking the Taoiseach, as Cara Darmody asks, when this will be treated as the national emergency it is. When will we see those waiting lists properly and effectively addressed?
2:20 am
Micheál Martin (Cork South-Central, Fianna Fail)
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One of the reasons this Government quickly established the need for a therapy-in-school service, which we have now commenced and taken the decision to do, was the inadequacy of the response within the health service itself. Many CDNT teams are experiencing challenges in recruiting and retaining therapists, as well as wider general issues. The issue is actually not one of resources; it is one of capacity. Private funding was provided last year and quite a number of private therapists have been procured. The standard operating procedure model that the HSE adopted was struck down by the courts. The rationale behind it was to prioritise establishing the needs of children, rather than providing the diagnosis immediately, in order to ensure a quicker route to intervention services.
I have been informed by the HSE that it is estimated that up to 30% of assessments result in children being identified as not having a disability. It is about how to allocate resources more effectively and in a targeted way to the children who require those services as quickly as possible. That is the objective we have to focus on. What will enable us to do that in the short term more effectively than currently is the case? At the moment, the timeframe for an assessment of need could be between 37 and 90 hours. There is finite capacity in terms of therapists out there, whether in the private sector or the public sector.
Yes, we have to create more third level places. We have done that and we are going to do more of it. We have to facilitate more recruitment of therapists from overseas. CORU, the regulatory body, needs to be flexible in that regard. Mutual recognition of qualifications is a general problem because we need to supplement our own development of graduates through our third level system with graduates from overseas to get a higher number assessing and, crucially, providing services to children.
In education a line of sight is visible in terms of allocating the resources and getting visibility over the provision of services. We are not quite there yet. I have acknowledged that in Dublin we have issues with some school places. I will not be happy until 100% of children are looked after in terms of a school place for September. However, there is and has been an issue with therapists. That is why we have moved to an education model to commence with special schools, to expand beyond that and then to support the community teams as well.
In the short term, there are choices we can take to enable therapists to get to children more quickly and to be used more optimally than currently is the case for children. That is the case I am making for why I think we need legislative change along with a range of other measures. It is not to take away rights, but to provide services to children.
Ivana Bacik (Dublin Bay South, Labour)
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I listened carefully when the Taoiseach said the issue is not one of resources but one of capacity. Then he threw out a number of hypothetical ways in which capacity could be addressed. However, the Government has not done anything to address capacity. I sat yesterday in my own constituency with two desperate mothers who are desperate to get school places for their children. The Taoiseach spoke about school places. The failure of the Government on school places for children with additional needs is shameful.
The two mothers asked me, "Why does the Government not upskill us?" Why do we not use the resource of all those parents who have fought so hard for so long and had to struggle so hard to get places, therapies and assessment of needs in the first place for their children. Let us look at a programme of upskilling. That is what they are telling me. Otherwise, the Government will continue to fail.
I am looking at the letter Deputy Kelly got. It said 7% of assessment of needs were carried out within the timeframe. That is a 93% failure rate. That is shocking. Will the Taoiseach meet Cara Darmody today? Will he hear from her the constructive proposals she has based on her own lived experience in her own family on what his Government can constructively do to address that capacity shortfall?
2:30 am
Micheál Martin (Cork South-Central, Fianna Fail)
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The Deputy mentioned special education. Special class enrolment has doubled in five years. We have gone from about 9,000 to 19,000. What is that saying? It is revealing the exponential growth in the number of children requiring special needs provision and services and resources have expanded accordingly, in terms of the number of classes, SNAs and special teachers and funding for extra classrooms and so on in the special needs area. Any objective person assessing what has been happening in special education, while not saying we are there yet, would have to acknowledge the very significant growth and expansion and rightly so. I am absolutely committed to this and I want to get this sorted but that will mean taking decisions which I anticipate will run into opposition here, as is the nature of politics and that is fair enough.
Alan KellyMicheál Martin (Cork South-Central, Fianna Fail)
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Sorry, I have already organised that. There has been engagement and we will meet.
Micheál Martin (Cork South-Central, Fianna Fail)
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I have met Cara before and Deputies-----
Cian O'Callaghan (Dublin Bay North, Social Democrats)
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Successive Governments have let children with autism and intellectual disabilities down in the worst possible way. Permanent damage is being caused to thousands and thousands of children. The fact this is happening is a national disgrace. Those are not my words but those of Cara Darmody, who joins us in the Gallery, who has begun a 50-hour protest over disability services outside the Dáil. Cara did not utter those words today but last year when Cara held a weekly protest outside Leinster House and Government Buildings.
Cara has been highlighting the crisis in the assessment of needs and disability services since she was just 11. No child should have to spend years campaigning and protesting for basic services. Cara should be in school today like other kids her age but she is not. She is here in the Gallery, and will be outside the building during the day, to highlight that services are getting worse not better. She has watched her two younger brothers, Neil and John, who have additional needs, being repeatedly failed and she has made it very clear that she is undertaking her protest for every child in the country that is being left behind.
There are now more than 15,000 children all over the country who are overdue an assessment of needs. The HSE is warning that by the end of the year the figure could be 25,000. That would be 25,000 children left waiting for an assessment of needs beyond the legal time limit; 25,000 children with additional needs being failed by this Government; 25,000 children just like Neil and John. This is utterly unacceptable.
When the Taoiseach is asked about this he blames court judgements, the law and growing need. He fails to take responsibility. Families have had enough of Government excuses. Opposition parties are putting down a joint motion calling for immediate action. Children with additional needs deserve more than just broken promises. They need quality services to be available when they need them. We all know childhood is fleeting and at the moment too many children are being left behind. Consistent Government failures mean children are being denied the opportunity to reach their full potential. We cannot and we will not tolerate that.
The Dáil motion that the Social Democrats and other parties have tabled is not asking for bells and whistles. It is asking for the Government to comply with the law. It should not take a 50-hour protest outside the Dáil by Cara, just 14 years old, to shame this Government into action to provide assessment of needs within the legal time limit of six months.
Will the Taoiseach stop breaking this law?
2:35 am
Micheál Martin (Cork South-Central, Fianna Fail)
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From day one, the Government has identified the entire area of disability and special needs as a key priority, along with housing and, as I said earlier, child poverty. That will be reflected in the forthcoming budget and has already been reflected in Government initiatives. Decisions have been taken at recent meetings of the Cabinet subcommittee in respect of this. Going back, when the party the Deputy was in at the time was in government, the CDNT progressing disability initiative was taken. I am not blaming anybody, but I do not think that worked. I said at the time it would not work and have said so consistently. Quite frankly, that is why a new national therapy-in-school service is being established. The CDNTs have had huge difficulty in recruiting a sufficiency of therapists. There is a 21% vacancy rate in CDNTs throughout the country. That model has not worked for a variety of reasons.
I am not blaming High Court decisions but the HSE's standard operating procedure model was proving to be effective and impactful for many children because it was getting therapy services to children more quickly. The legislation needs to be changed without removing any rights. To be fair, when the courts rule, it is then up to legislators to deal with that ruling by amending the Act and so on-----
Mary Lou McDonald (Dublin Central, Sinn Fein)
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Or combine with the law.
Micheál Martin (Cork South-Central, Fianna Fail)
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-----given the finite number of therapists we have. We can pass all the motions we like but we have to deal in a very pragmatic, solution-based approach right now. We have to deal with this in a multifaceted way but, right now, we need to make sure that the therapists we have are focused on providing services to children as quickly as we possibly can, consistent with the needs of those children.
We have made a lot of progress in education. We want to make more progress on mobility and transport. We have made progress on increasing various payments but we want to do a lot more regarding income-related supports for children and families where there is disability. Right across the board, we want to make good-quality improvements for people with disabilities. We are determined to do that and to build on progress that has been made in most areas, bar the health area. I acknowledge that the issue of providing therapists to children has not worked at all. I am absolutely determined that this Government will do everything in its power to deal with this issue. At present, as an interim measure, we are providing finance and funding for procuring private capacity but, again, it is very often within the overall framework of finite capacity. There are so only so many therapists in the country at any one time.
Cian O'Callaghan (Dublin Bay North, Social Democrats)
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The Taoiseach talks about progress and step-change but the HSE is saying that the shocking figure of more than 15,000 children overdue an assessment of need this year will be 25,000 by the end of this year. That is what is happening. He knows that early intervention is crucial for children. It makes a world of difference. It can mean the difference between children with the proper supports learning to talk, participate and make friends or, if they do not get that, getting left behind and left out. It makes all the difference. Where is the emergency action the Government is planning to address this? What will it do today to start fixing this? Will the Government start, as Cara is asking, complying with the law? When will it comply with the law?
Micheál Martin (Cork South-Central, Fianna Fail)
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Early intervention is the key. I could not agree more. We need to expand early childcare services for children with additional needs, particularly early childhood education provision for those children. We are doing that and will continue to expand services there. The HSE is not in a position to fulfil the law right now. The Deputy knows that and I know that. We have to respond to enable us to get therapy services to children as effectively and optimally as we can. Our agenda is to use the resources we have for children who need services. I refer to existing resources and how we add to those resources through recruitment, retention and increasing the number of therapy places in our third level colleges for those who wish to work in therapy assistance, including more and greater provision in that regard.
However, as a society we have to work smarter to utilise existing therapist resources for the benefit of children.
2:40 am
Verona Murphy (Wexford, Independent)
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We now move to the Independent and Parties Technical Group. I call Deputy Brian Stanley.
Pearse Doherty (Donegal, Sinn Fein)
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On a point of order, could I get clarification on whether the Taoiseach just informed the Dáil that the Government intends to continue to break the law on this issue?
Verona Murphy (Wexford, Independent)
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There is no point of order at this stage.
Pearse Doherty (Donegal, Sinn Fein)
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I think it is really-----
Pearse Doherty (Donegal, Sinn Fein)
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I have never heard a Government in all my time declare it intends to continue to break the law.
Verona Murphy (Wexford, Independent)
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Resume your seat, Deputy, please.
Brian Stanley (Laois, Independent)
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I, too, welcome Cara and Mark to the Public Gallery today. I will be speaking about the issue that concerns them later in the day. It is a scandal that Cara has to be here again to protest on the issue.
The issue I want to raise with the Taoiseach is the absence of primary care. It is over eight years since the Sláintecare plan was agreed for a public health system by all parties in this House. It was due to be fully up and running by the end of this year, by 31 December, but, of course, we are so far from the full implementation of its recommendations and what was set out in it. Nowhere is this more starkly seen than in the area of primary care.
Primary care is sparse right throughout the State, particularly in County Laois. Despite the best efforts of GPs and staff working in the sector across the State, we are not within a country mile of having a properly resourced and fully functioning primary care system. The effects of this are many. There is a lack of timely intervention and minor health issues are becoming chronic, finishing up in hospitals. We have emergency departments clogged up with people who cannot afford to go to a GP because they do not have a medical card. In some cases, they cannot even get a GP even when they have a medical card or are going privately. On occasion, people who come to me state they cannot access a GP even though they are paying privately.
Treatments that should be available in primary care centres and local health centres are simply not available. Therefore, it is up to the hospital, which is where people are going. Basically, we have to have health centres and GPs to staff them, in addition to ancillary staff, whom we do not have in this country, to manage and man them and ensure the services are available.
In County Laois, we are short of the basics on both counts. We have no primary care centre in Portlaoise, a town with a population that exceeds that of Kilkenny. It now has a population in the region of 30,000. We have health centres in Mountrath, Borris-in-Ossory, Rathdowney and Graiguecullen that need to be replaced or upgraded. In the case of Portlaoise, the design is done but the project requires capital funding to move it on. It is located on a perfect site. The centre in Mountrath is too small and is outdated. It is being talked about but the project needs to be moved on. It is the same for the centre in Rathdowney, which is totally unsuitable. A new centre needs to be put in place there. We are moving at a snail’s pace. The centre in Borris-in-Ossory needs to be replaced, and there is now an opportunity to locate it within the old courthouse, which is being refurbished by the county council. In Graiguecullen, the position is the same. There is talk of making it the health centre for the south-east corner of Laois, taking in Swan, Newtown, Crettyard, Killeshin and Arless. However, this cannot happen because, as things stand, we cannot even cater for the population of Graiguecullen.
Verona Murphy (Wexford, Independent)
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I thank the Deputy. I call the Taoiseach to respond. Deputy Stanley will have a chance to come back in.
Brian Stanley (Laois, Independent)
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Will the Government start resourcing primary care in County Laois and other counties?
Micheál Martin (Cork South-Central, Fianna Fail)
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I thank the Deputy very much for raising the issue of the crucial importance of primary care provision. When I was Minister for Health and Children in 2001, we made primary care the cornerstone of the then health strategy, Quality and Fairness. It took some time. In the modern area, we have progressed fairly significantly in terms of the provision of primary care centres. There are now about 179 of them across the country, 50 of which have been opened since 2020.
Overall, the Government is delivering record levels of investment in health services. A record €25 billion has been made available for 2025, and that represents an increase in health funding since 2019 of over 70%. In parallel with primary care, it supports very important initiatives like enhanced community care, and it also supports oral health and palliative, cardiovascular and cancer care.
Sometimes people say health absorbs an awful lot of expenditure and ask if we are pouring all the money into a black hole. We are not, actually. Outcomes are improving all the time, and that needs to be acknowledged as well. Life expectancy is now above 82. We are in a small group of seven EU member states where that is the case. Our mortality rate fell by 11% over the years 2014-22. The mortality rate for all circulatory system diseases fell by 20% in that period, with heart disease and stroke falling by 28% and 37%, respectively. A lot of that was due to the work on primary care in terms of cardiac initiatives in particular. The mortality rate for all cancers in that period dropped by 15%, with cancer of the trachea, bronchus and lung and breast cancer dropping by 21% and 22%, respectively. The mortality rate for all respiratory system diseases has fallen by 15%, with chronic lower respiratory diseases and pneumonia falling by 9% and 41%, respectively.
We are making progress in terms of investment in health and, critically, health outcomes. There are other aspects of that - healthy lifestyles, nutrition and so on - but primary care is central to it. As regards chronic disease and chronic disease management, for example, primary care is where it is at. Some 95% of GPs are now signed up to the chronic disease management programme, with over 645,000 patient reviews by GPs in 2024 alone. Some 92% of patients with chronic disease are now fully managed routinely in primary care and not attending hospital for the management of their conditions.
From what the Deputy has said, I would say progress is happening in his constituency. I think he said that in Portlaoise the design stage is complete for the primary care centre and he has said it is an excellent site. I anticipate progress in that regard. I will check with the Minister-----
2:50 am
Micheál Martin (Cork South-Central, Fianna Fail)
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-----and the HSE in respect of the capital requirements for that. I hear the Deputy loud and clear. This is an important centre of population that requires a primary care centre.
Brian Stanley (Laois, Independent)
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I thank the Taoiseach for his reply, but we also need GPs. Mike O'Callaghan of the Irish College of General Practitioners said that we clearly have a deficit in our GP numbers and he listed out a number of counties, including Laois. The last time I checked, we were way below what is required. Primary care centres and health centres in other countries include a whole range of services - physiotherapy, occupational therapy, dental, chiropody, mental health services, etc. - but we are miles away from that comprehensive primary care model. We have neither the staff nor the facilities. I agree with the Taoiseach that primary care is the cornerstone. He said 79 primary care centres have been funded.
Brian Stanley (Laois, Independent)
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Will his Government commit to the capital funding needed to construct a new primary care centre in Portlaoise? The site and the design are there. Will the Government provide the funding for new health centres for Mountrath and Rathdowney and upgrades in Borris-in-Ossory and Graiguecullen? Will the Government increase the number of GPs per county? There is a commitment in the programme for Government to explore the recruitment of HSE-employed GPs. We need to go further than exploring it; we need to do it. The programme for Government states, "Explore the recruitment of HSE-employed GPs." We need to start employing a cohort of those also.
Micheál Martin (Cork South-Central, Fianna Fail)
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I said there are 179 primary care centres now in place. Of those, 50 have opened since 2020. I take the Deputy's point that we still need more GPs. The outgoing Minister for Health, Stephen Donnelly, had approved, with the outgoing Minister for higher education, now Tánaiste, additional places in all third level colleges in respect of medicine and also, in terms of nursing and so on, in Northern Ireland. In terms of the specifics, we also have programmes to attract people into rural Ireland and to provide greater cover in rural Ireland in terms of rural GP programmes. We fully accept the challenges that are out there and I will inquire about Rathdowney and other locations in County Laois and, critically, the status of the Portlaoise project. We are committed to primary care and we will continue to expand primary care.