Jennifer Carroll MacNeill
Dún Laoghaire · Fine Gael · Ireland
“It will be provided by a registered pharmacist in accordance with the relevant pharmacy legislation, including this Bill. Section 2 of the Bill makes various amendments to the Irish Medicines Board Act and the Pharmacy Act. Those amendments ensure that whole legislative framework is cross-referenced correctly.”
“We now have a common conditions service where you can go to a pharmacy instead of a GP to get a diagnosis and prescription for eight basic conditions like conjunctivitis or urinary tract infections - the kind of things that just come up in people's lives all the time. We would like to expand more and more what pharmacies can do.”
“In particular, the board will be focusing on aspects of menstrual health, on aspects of postpartum mental health, particularly in traumatic birth cases, on something we have overlooked for some time, which is endometriosis, on women who are finding it difficult to access services in different ways, as Senator Harmon suggested, and on more…”
“The extension to 41- to 45-year-olds could possibly be €5 million to €8 million because there are statistically fewer women in that bracket trying to conceive, so the numbers are higher. It really is a question of funding. I remind Senators that they have also asked me to fund various other programmes.”
“That followed confirmation from the Pharmaceutical Society of Ireland and the Health Products Regulatory Authority that the patch and ring are classified as medicinal products, not medical devices. That is just a correction there.”
“That is why we have put so much money into supporting them in different ways, including the conclusion of a €50 million increase to their fees and to provide for the opportunity to raise private funds in this way, for example, the common conditions service. I want to see pharmacists doing more.”
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“The region also has orthodontic units in Navan and Ashtown, which have a combined total of two consultant orthodontists and five specialist orthodontist whole-time equivalents, currently filled and providing care in the Dublin and north-east region. The HSE is engaged to address the best use of existing funded private procurement options to support delivery of orthodontic care in the region.”
“I can update the Deputy on the orthodontic waiting lists. As of April 2025, the HSE employs 14 consultant orthodontists and 36 specialist orthodontists nationally. There are almost 35 oral healthcare vacancies at the moment which the HSE is working to fill, including three specialist orthodontist whole-time equivalents, and a further 2.22 dental nurse whole-time equivalents. There are staffing challenges within orthodontic services in the Dublin and north-east region. At present, both specialist orthodontists posts in Dundalk, which also serve Counties Cavan and Monaghan, are vacant. The HSE is sanctioned to fill those posts and is actively pursuing both temporary and permanent recruitment options. A locum consultant orthodontist post is also being considered.”
“Not all chronic conditions can be managed in that way and it is important to recognise the capacity of general practice and how we are trying to grow general practice at the same time. I have listed a number of conditions but I also want to flag that, for example, the Benbulbin hub in Sligo treats a range of different illnesses and it is separate from the hospital, and again and again, prevents hospital attendances.”
“That is right. It impacts early detection as well. As populations age - which ours is doing - the prevalence of chronic conditions, including multimorbidity, rises. Early protection through the chronic disease management programme prevents the need for more intensive hospital-based treatments. Since 2020, 51% of the new chronic disease diagnoses have been made through elements of this programme. It is not just treating more effectively; it is diagnosing more effectively and being able to divert attention to prevention and early intervention. As regards expansion of the scheme, a further expansion of the programme to include chronic kidney disease is planned for the end of the year, and further expansion would include rigorous clinical assessment and engagement with stakeholders.”
“Patients receive two reviews in a 12-month period, with each review including a practice nurse and a GP visit. GMS patients over 45 years of age found to be at high risk of cardiovascular disease or diabetes are enrolled in the prevention programme and receive one annual review. The prevention programme was expanded from 30 November 2023 to include adult GMS patients with hypertension and all women who have had a diagnosis of gestational diabetes or pre-eclampsia since 1 January 2023.”
“In addition, the 26 operational community specialist teams for chronic disease management, linking the care pathways between acute and community services, are delivering services from integrated care hubs located in or adjacent to primary care centres. They are fantastic. In 2024, over 354,000 patient contacts were provided by community specialist teams for chronic disease management, about 55% ahead of target, and this year to the end of quarter 1, 108,000 patient contacts had already been provided by these teams, which is about 30% ahead of target. The conditions covered by the programme are type 2 diabetes; asthma; chronic obstructive pulmonary disease, COPD; and cardiovascular disease. The treatment programme supports patients in managing their chronic conditions.”
“The GP chronic disease management programme commenced in 2020 and has been rolled out on a phased basis over four years to adults with either a medical card or, for GMS patients, a GP visit card. The aim of the programme is to prevent and manage chronic diseases. Since 2020, over 680,000 patients have been registered on the programme, including those who have exited the programme. Some 91% of patients now receive routine care in community settings, reducing their reliance on hospitals. An ICGP study found that for patients enrolled in the treatment programme, there were 30% fewer emergency department attendances, 26% fewer hospital admissions and 33% fewer GP out-of-hours attendances compared with their pre-enrolment rates. The majority of patients manage their conditions through the GP chronic disease management programme.”
“I agree with Deputy Clarke on counselling and psychological supports. Parents who take the advice of clinicians do so in the best interests of their child and now feel they have done something wrong in following that advice. It is a devastating thing to happen to a parent who is only trying to be a good parent and take the right decisions. They need support as much as their children do. I totally recognise that.”
“I do not know the exact details of the Deputy's constituent's case but for any child now indicated for surgery, the assessment is done in a very different way from how it happened before. Any such assessment is done by a multidisciplinary team, including a doctor. It is a cross-site piece of work including a physiotherapist assessment. It is not, as had been the case, that an individual consultant makes decisions in his or her own bubble. This is a multidisciplinary team. The Deputy's constituent or any Deputy's constituent who has a child indicated for surgery can, depending on the timing, get the assessment through the multidisciplinary team. It is very different from what was there before. I hope that will give her more confidence where she has questions relating to her child.”
“The clinical review follow-up, the first process, is expected to take about six months and for the secondary review panel, the independent expert one, it will take until September for the establishment of the team. We have four at the moment and there are a number of others to come. They need to agree the terms of reference; it is not for us to impose the terms of reference on them. They can assess each case as appropriate once they have begun.”
“My practice, as much as I possibly can, is to meet people. Like Deputy Clarke, I have met parents and seen the distress. I have parents in my constituency in this situation. There is no difference between our experiences of this. I cannot believe the distress being experienced by the parents of the 71 children. We are already identifying children. Parents are being told through this initial clinical follow-up that their child did not need this. I will now update the Deputies on the expert review process to follow. We are in the process of establishing that panel. It is not complete but there are a number of experts from Canada and the United Kingdom. It is not surgeons within the system; it is very different.”
“It is important to say that the consultant who did the surgery is not the one who is doing the review, in the clinical follow-up. I will get to the expert review as well. I just want to make sure that this is on the record. In relation to the retrospective reviews of cases, which is the second process, to determine the indications for surgery and whether they were warranted, the HSE is establishing a separate process, involving external experts. Professor Deborah McNamara, the president of RCSI, has agreed to assist the HSE in establishing the expert panel and terms of reference. I have more information for the Deputy on that.”
“These children have been identified and categorised by age, with a proportion of them being close to skeletal maturity and likely to need just one appointment. The clinic is structured as a one-stop multidisciplinary team model for assessment, and that includes consultation with a doctor, a physiotherapy assessment, an X-ray, if clinically indicated, and immediate documentation of findings. After this, patients enter the recommended normal follow-up process. As of Monday, 23 June 2025, 115 appointments have been offered to CHI and NOHC patients. A total of 86 patients have been booked and 71 patients have been seen so far. Patients who request attendance at another hospital or with another consultant will have their request facilitated by CHI.”
“I agree completely with the Deputy. However, my immediate priority is to ensure that there is clinical follow-up and care for patients who have undergone pelvic osteotomy surgery in accordance with the recommendations of the Thomas audit report. I am very aware that there are families around Ireland who are receiving letters and follow-up to say that surgery was not necessary on their child. I cannot imagine the distress that those families experience when they receive that sort of communication. I have spoken to families who are having that experience and it is so utterly distressing for them. Clinical follow-up to skeletal maturity for children in CHI Crumlin, CHI Temple Street and the National Orthopaedic Hospital Cappagh, NOHC, is already under way for patients.”
“The HSE has proactively reached out to the company to ask it to submit an application. I made it my business to speak with the Italian Minister of Health at the EPSCO Council in Luxembourg to ask him to encourage the company to submit an application to Ireland. We will do everything we can because we recognise the life-changing implications of some of these drugs. However, as Minister, I must also point out that we have to get an early access programme right in a way that enables the State to get the best negotiating price for the delivery of drugs for everybody.”
“I want to put a little bit of context on this. The State spent more than €3 billion in 2023 providing medicines to patients. We sometimes forget that €3 billion of the health spend goes to providing medicines. That is appropriate but it is a major budgetary consideration as well. With the early access programmes, we have to get the balance right between being able to get access to the drugs and also being able to work out how that programme intersects with the State's ability to negotiate the right price for the drugs. Regarding Duchenne muscular dystrophy, which the Deputy mentioned, I do not see how the State could be more proactive in trying to support this. On approval from the European Medicines Agency, I asked the CEO of the HSE and the Secretary General of my Department to find ways to support this.”
“As outlined in the programme for Government, as the Deputy correctly identified, consideration will be given to various measures to address access to medicines. As part of this, my Department is looking at reimbursement systems across the European Union, including Belgium. We are working closely with our Benelux partners on access to medicines where we have had some previous success.”
“This partnership has already directly benefited patients, for example those with cystic fibrosis and other rare diseases. In this spirit of co-operation, I continue to encourage pharmaceutical companies to submit timely applications for their products so as to increase access for patients with unmet needs. It is also the responsibility of the HSE to improve its efficiency and it has been enabled to do that with the provision of a 100% increasing in staffing in that area. All medicines are assessed from a clinical, economic and ethical standpoint, with no hierarchy of disease. Upon approval by the European Medicines Agency, applications for reimbursement are assessed by the HSE in the order in which they are received from applicant companies.”
“I recognise the importance of timely access for patients to medicines, including new medicines. Supported by €128 million of funding, in the past four years the State has delivered access to 194 new medicines. Of these, 74 were for cancer and 49 were for rare diseases. Budget 2025 allocated €30 million for new medicines, to come from efficiencies to be identified by the HSE. The Government has introduced a suite of new measures to enhance capacity in the HSE’s pricing and reimbursement system, including 34 additional staff, which is a 100% increase, and a medicines application tracker to increase the transparency and efficiency of the process. Access to medicines requires industry and the State to work together, through timely assessment, reasonable pricing and fully completed health technology assessments.”
“It is exceptionally important to acknowledge that our focus here is on HIQA, but HIQA did not do and did not enable what happened in the nursing homes. I want to take a moment to reflect on the fact that the provider and the individuals involved are ultimately responsible. We will also work with HIQA but let us first and foremost direct our ire at the providers of the nursing homes.”
“HIQA is an important institution in this State which has done exceptionally good work. I have good confidence in it. Everything, be it this House, HIQA and everything else, needs process and institutional development improvement in response to these events.”
“Along with the Minister of State and I, it is considering what is needed to further strengthen its regulatory role and processes, in particular to reflect the changing dynamic of the nursing home market and sector and the ownership structures within those. That is important. I will continue to work closely with HIQA in reviewing its powers and exploring ways to improve and strengthen its inspection and regulatory regime. As I said, that includes exploring how HIQA can best deal with regulating larger corporate entities that operate in the nursing home space. It is important to say - and I know the Minister of State, Deputy O’Donnell, has been strong on this - that there is a need to report in real time, rather than some months later. We must have better visibility over this at an earlier stage.”
“Other legislative amendments have strengthened the regulatory framework in nursing homes, giving HIQA additional new powers in the areas of enforcement, data collection and compliance notices. My Department has committed significant financial support to HIQA, reflecting its expanded regulatory role. The budget allocation of non-capital expenditure from my Department to HIQA in 2025 is €35 million, which is a considerable increase of more than 60% compared with the €21.4 million allocation in 2022. It is likely HIQA’s regulatory responsibilities will expand further under future developments, such as the patient safety (licensing) Bill, the provisions of which I took to Cabinet this week. I met with HIQA last week.”
“I will answer on HIQA specifically and ask the Minister of State, Deputy O'Donnell, for his perspective as well. HIQA plays a crucial role in ensuring high-quality and safe care for patients using our health and social care services. The Government strongly supports HIQA in maintaining and strengthening its critical regulatory role. While it provides an important role, it also needs improvement. A number of changes to both primary and secondary legislation have been made in recent years to expand and reinforce HIQA’s functions. Under the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023, HIQA’s remit has been expanded into private health services and hospitals.”
“However, do not allow me in any way to attempt to confuse that with the specific surgical hub issue, which is more pressing and immediate.”
“I thank Deputy Ward and I hear what he is saying about his experience of the HSE. That is important. It is also important to reflect on local hospital management and their responsibility to advance cases on behalf of the hospital. When I met Deputies from Donegal, I went through the projects that had been advanced and supported. I recognised there was, in my view, insufficient surgical ask by the local hospital management. While I am not trying to deflect from the surgical hub issue in any sense, it is also important there is a real development control plan for Letterkenny University Hospital for the medium and long term in the way that has been successful in Galway and other places. I strongly urge Deputies to pressure for and demand this sort of approach for Letterkenny.”
“To update the House, the surgical hub that has opened in Mount Carmel Community Hospital has seen 1,000 patients already. The CEO of St. James's Hospital informs me that its pain relief list is nearly clear because they are able to give pain injections. The surgical hubs are really important. In respect of what Deputy Ward describes, I know and respect the geography of Donegal. It is important we have capacity there to deliver these different services. I ask Deputy Ward to allow me a little bit of time. I am trying to work on it.”
“I thank Deputy Ward and I assure him, representatives from Donegal, the consultants and doctors in Letterkenny and the people of Donegal more broadly that I will do precisely that. I am committed to that region. That is why I visited it a number of weeks into becoming Minister for Health in order to understand for myself. I cannot look at it on a map or look at drawings. I have to be there to understand the dynamics and to listen to people, which is precisely why I went and have tried to engage in this way. No decision has been made yet. I ask Deputy Ward to give me a little bit more time to work out how to manage this. I wish to update the House on the operation of the surgical hubs. I was in St. James's Hospital yesterday.”
“I look forward to my next engagement with them to best determine the way to deliver health care for the people of the north west.”
“I visited Letterkenny on 1 May to better see and understand the hospital and the supporting environs, such as the 110-bed community nursing unit across the way that is under construction and the excellent Errigal hub, which is also across the way from Letterkenny Hospital. On 11 June, I believe I met with all Oireachtas Members for Donegal. Last week, I also met with representatives of doctors and consultants in Letterkenny, who have engaged with me very constructively and positively on this issue. It was a wide-ranging discussion, and I have committed to meet with them again soon. I am open to listening to them and to understanding the issues, which I share, regarding surgical capacity in Letterkenny in the medium and long term.”
“I thank the Deputy. As part of the Government’s ambulatory care policy and in advance of the new elective hospitals, the HSE is developing surgical hubs across the regions. They will play an important role in separating scheduled and unscheduled care, reducing waiting times, thereby improving access and care for patients. The programme for Government committed to delivering six new hubs and exploring the provision of an additional surgical hub for the north west. No decision has yet been made on a location for this hub and the business case has not yet been submitted to my Department.”
“We have tried to take an empathetic and supportive approach. The Minister for Social Protection has reviewed the EU position to determine how this works with the occupational injuries benefit scheme. The public service sick leave scheme is an important scheme in the context of supporting all people in the public service.”
“Again, I recognise that the findings of the Labour Court are still awaited and I respect that. I will also reiterate the terms of the sick leave scheme. Having been on full pay for five years, the healthcare workers may receive further full pay for three months, half pay for three months, temporary rehabilitative remuneration for 547 days of paid leave and the critical illness protocol that forms part of the sick leave, which provides additional support for up to three years. I appreciate the distinction, importantly, the Deputy has not made between Covid and long Covid. Nevertheless, when we look at the EU comparison, we are not aware of any case such as that. If the Deputy is aware of any case where any country sustained full pay for workers suffering from long Covid in the way Ireland did, I ask her to please bring it to me.”
“As I said, the Minister for Social Protection reviewed those recommendations and did not recognise it in the context of the occupational injuries benefit scheme. While many EU countries recognised Covid-19 as an occupational illness or injury, this related to Covid-19 and not long Covid. It is not clear that any country sustained full pay for workers suffering from long Covid in the same way Ireland has for its public health workers through the special scheme we have had to date.”
“There is no intention not to recognise that or to not be empathetic, which is why the scheme for full pay was there for five years. I am aware that the Minister for Social Protection has reviewed the EU recommendation in respect of the recognition of Covid-19, not long Covid, for an occupational illness. Following that review, it was determined that Covid-19 did not meet the requirements to be recognised as an occupational illness in the context of the occupational injuries benefit scheme and the Social Welfare Consolidation Act 2005. It is important to recognise that the EU advisory committee on health and safety recommended the recognition of Covid-19 and not long Covid as an occupational illness in health and social care settings.”
“I reassure, to the extent that I can, those 159 employees who have been supported by the scheme for up to five years that they will continue to be supported. The full provisions of the public service sick leave scheme will apply for anyone who remains unable to return to work. The sick leave scheme provides full pay for three months and half pay for three months. This is followed by temporary rehabilitative remuneration, which can provide up to a further 547 days of paid leave. The critical illness protocol that forms part of the sick leave scheme may also provide additional supports for up to three years. I am aware that concerns have been raised by a number of unions about the scheme ending, and I know that the matter was before the Labour Court on 11 June, the findings of which are currently awaited.”
“It is my understanding that approximately 159 employees are currently on the special scheme, the majority of whom have been supported on full pay for almost five years. My Department has always worked hard to ensure supports have been in place for those workers impacted by long Covid. At the Department of Health's request, the now Department of Public Expenditure, Infrastructure, Public Service Reform and Digitalisation has agreed to extend the scheme on four occasions, most recently at the end of June 2024, when it was extended for a further 12 months for the existing group of employees being supported by it. However, I understand the Department of public expenditure was clear at the time that this was the final extension that would be granted. As such, the special scheme will conclude on 30 June 2025.”
“I thank the Deputy. The role our healthcare workers played during the pandemic cannot be overstated, particular at the very early stage of it. They went beyond the call of duty, working in front-line environments, treating Covid-19 positive patients, particularly in the early days when the control mechanisms were what they ultimately became and while the risk was extraordinarily great. In response to that, a temporary scheme was put in place for 12 months in July 2022 to support eligible staff who were impacted by long Covid in the public health sector. The intention of this scheme was to support those employees working in Covid-19 environments in the time before PPE and vaccinations were readily available.”
“The auditor will look at three specialisms, two of which will be surgical and one medical. The auditor will examine the waiting list management within that, and I imagine that scoliosis will be one of those areas that will be examined. Again, I reiterate the importance of a central referral system, which manages it on behalf of the team, rather than individuals managing their own lists.”
“I want to be very careful of the privacy of Mikey and his family but I have met him and I have met his family. I am aware of the various issues. On foot of meeting them, I put in train a process and perhaps I might speak to the Deputy about it privately rather than on the floor of the Dáil, recognising his privacy. With regard to scoliosis and the issue of waiting times, it is a source of great frustration to me that there has been so much additional investment, both financial and personnel, into the system but we are not getting what I would regard as a commensurate increase in output or productivity. They sound like harsh words but I mean surgeries for children who need them. It is very important to look at the work the HSE internal auditor will do.”
“Of course I have stronger confidence because of the increased involvement of the HSE. There is ongoing reporting to me of what is happening about the implementation of the various issues. I am concerned in particular, of course, from a patient safety perspective.”
“The Deputy will note the number of resignations from the board. She has identified a series of important and serious issues, most of which we knew would be coming because of the concerns raised by whistleblowers and others. Reports were correctly commissioned with HIQA by the HSE and CHI. We knew they would come but, as she pointed out, the report that was not shared with either the HSE or the Department raises very serious concerns. It comes from 2022 when it should have been shared and addressed properly but it is today that we have to address it. I recognise that we have nearly a new board. We certainly have a new CEO who was appointed in February and is establishing an executive team around her, all of whom are new to the system. I will work directly with them to ensure this is taken forward.”
“I also emphasised the priority I place on child patient safety issues and asked the board to report directly to me on the status of the children that may have been impacted.”
“These actions are designed to support the new CEO in CHI and enable her to continue with the transformation programme she has started. Regarding the 2022 internal examination referenced by the Deputy, I have been advised by the Attorney General that I do not have the legal basis to publish this report. I sought that legal advice with a view to trying to put it into the public domain correctly. I received it correctly but it is the property of CHI and I do not have the power myself to publish it. Any publication must be made by CHI. On 16 June, CHI published a summary of the report. Subsequent to my letter on 26 May requesting a response from the CHI board to the report, on 18 June I wrote to the CHI board requesting assurance that the recommendations have been addressed in full.”
“In response to a series of reviews which raised corporate and clinical governance concerns at CHI, I have moved to strengthen governance and oversight structures at CHI in a range of different way. This was done via the appointment of two members of the HSE board to the board of CHI on 28 May. There are more board appointments to be made. This means that all but one members of the board have been appointed since 2024. This is a different reference period to some of these activities. The service level agreement between CHI and the HSE has been strengthened, and there is significantly increased involvement from the Dublin and midlands regional executive officer. Recognising the need to co-ordinate oversight of the range of matters of focus in CHI in a cohesive fashion, the HSE CEO has established the HSE CHI improvement steering group.”
“Cork University Hospital remains in the 80% to 90% range for urgent referrals. I know the Deputy did not raise this necessarily in the parliamentary question but Galway University Hospital's performance this year has averaged 33% but it is expected to show improvement in May because of the appointment of a replacement breast surgeon. He and I are having to discuss this on a hospital-by-hospital basis and we have to make sure the system is across itself.”
“I thank the Deputy and I agree with him on all of these points. Yesterday at the health committee we covered some of the workforce planning issues and the expansion of training places. It is also a workforce management issue and the variation between hospitals is well noted. I am told that in the Mater there have been long-standing recruitment challenges but they have been stabilised. There has been a consistently high volume of urgent referrals with difficulty in accessing radiology in St. James's Hospital. A lean project is under way to improve efficiencies. In Letterkenny the hospital has met the urgent KPI targets for the past three months, although the figure for the year to date is 85% following a poor performance in January. St. Vincent's Hospital has been meeting the urgent KPI since last September and it is at 99%.”
“I have written to the CEO of the Mater hospital to express my concern about this and to ask for the number of people waiting on it. I have also asked the regional executive officers for that area and the adjoining area, which includes St. Vincent's University Hospital and Tallaght University Hospital, to come up with a regional solution that meets the needs because this is absolutely unacceptable.”
“The Deputy is right. Yesterday I was at St. James's Hospital and it and Trinity College have become one of the accredited cancer centres of the Organisation of European Cancer Institutes. There are many accredited centres but this is at a different level. It is the most prestigious award for cancer control. The Deputy is correct that we have very good services. He asked in what world is this acceptable. There is no world in which it is acceptable and there is no world in which the Mater's figures are remotely acceptable. Let me also say that like the Deputy I have correspondence from the breast health unit in the Mater and I am deeply disappointed with the content and the tone of the letter being sent to women who are not just going for BreastCheck but who are going because there is a problem.”
“Where a performance issue arises, the HSE implements site-specific measures, but it may also need to implement regional measures, which we can discuss further. These can include funding additional clinics or providing locum cover where necessary. The national cancer control programme is also developing new or modified pathways for certain patient cohorts. These aim to make better use of available capacity and provide appropriate access for high-risk patients such as those with a family history of breast cancer. My Department is also reviewing diagnostic services to ensure that capacity is fully maximised. The Government's commitment to cancer services is reflected in significant investment, with more than €105 million provided for cancer services under the national cancer strategy, including €23 million in 2025.”