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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“I thank the Deputy. I have been informed in recent weeks that a benefit-in-kind liability was identified by the HSE for staff using the NAS response vehicles when travelling from home to work. A review is under way in the National Ambulance Service, which it is hoped will be concluded in April. The National Ambulance Service took the prudent step of informing relevant staff members of a potential benefit-in-kind liability that may exist in 2025. The Deputy will appreciate that the HSE must comply with Revenue Commissioners regulations, like everybody else, in relation to what may be considered a potential personal use of a publicly-owned vehicle. The National Ambulance Service is also preparing to seek a ruling from the Revenue Commissioners in the matter.”
“As I said, the GP training scheme increased by 80% from 2019 to 2024 with 350 new training places and 346 new entrants commencing training last year, an increase of 21% on the previous year's intake of 286. The very crude replacement rate is estimated at a rate of one to three GP graduates taken on board for every GP retirement and we have that particular focus on rural GP training.”
“The Government was making the same case during the election and continues to make the case for employing GPs through the HSE. It does not matter where an idea comes from. Let us just do it. Deputy McGuinness referenced barriers in his earlier intervention and I did not answer him. To be fair, the Government has tried to place a particular focus on rural supports. The 2023 contract is an example. Practices in receipt of rural supports receive the maximum rate of practice staff subsidies in a significant effort to reduce staff costs for those who will establish their own practice. They also receive the maximum rate for locum supports for leave taking. On new GPs, the Deputy is right that when a retirement happens it is very disruptive.”
“I always thank Deputies for raising practical problems and barriers I can interrogate and investigate within the Department and HSE. I do not know the status of every application so I really appreciate it. I am informed by the Minister of State, Deputy Butler, who also serves the community in Waterford, that she met HSE Estates last week on the Tallow project, which is important. She will be keeping a close eye on the progression of that. She also informs me Tallow GP service now has four GPs operating. It is a small rural town and it needs the GP services but this is a welcome development and we will continue to work with HSE Estates. The locum situation in Lismore has been resolved, with a permanent GP now in place, as is appropriate. The Department is working with several practices in west Waterford on their premises.”
“It is appropriate and important that people are being attracted into that from an early stage. The continued use of increased GP training places and GP recruitment under the international GP programme is committed to under the programme for Government, which also - I think we will come back to this - recognises the potential for using HSE-employed GPs in a variety of locations.”
“The agreements also provide for new services for patients, including the GP chronic disease management programme, which is having a transformative effect on patient care. In addition, recruitment of GPs from abroad is ongoing under the international medical graduate, IMG, rural GP programme, with 114 IMG GPs in practice as of October last. Placement of GPs under that programme is targeted at underserved and, in particular, rural areas. Most important for the future, the number of GP training places available has been increased from 202 in 2019 to 350 last year, and that will feed through to an increased number of GPs graduating and entering practice. I welcome the initiative of the University of Galway to develop medical and pharmacy education with a focus on the differences and additional challenges of delivering services in rural areas.”
“I certainly understand the frustration and worry that comes with having difficulty in accessing GP services. That is not what we want. Timely and available access to GP services is critical to good healthcare. In rural and remote areas, in particular, general practice is often in a role of clinical leadership for patients for whom access to other services is farther away. Being aware of this, and that the country as a whole needs more GPs, the Government has taken a series of measures in recent years - and is committed to continuing them - to increase the number of GPs. Significant investment in general practice has been made under the 2019 and 2023 GP agreements, which provide for increased fees and supports for GPs, including specific supports for rural practices, making general practice in Ireland as a career more attractive, I hope.”
“Our cancer mortality rates are falling faster than the EU 27 average and than our economic peers. Our EU country cancer profile in 2025 comments favourably on the measures taken to reduce cancer risk and prevention-----”
“I am a supporter of the public health system. That is what I am trying to drive investment into. I would like to see everybody treated in the public system. That is what this programme for Government and this House is about. It is about Sláintecare and delivering the best service in the public health system. My concern is making sure that happens. The Deputy has cited Sweden and the UK and it is important we do that. We want to be the best and for the people of Ireland to have the best experience. The Deputy is quite right to highlight where other countries are doing better. I am always interested in why and how that is happening. I always want to have the conversation about how we do this better. However, I also recognise the progress we are making.”
“The Deputy is right that there were measures of delayed diagnoses during a period where the health system was shut down for the benefit of the broader community with a highly transmissible lethal virus that was killing many people in this country. The Deputy is right that there was an impact in that respect, but notwithstanding that, our cancer strategy is trying not just to address that but is also trying to make sure we are delivering on the additional services brought by the previous two strategies.”
“It is really important to look at where we are versus the rest of Europe in terms of the impact of the investment we deliver. The most important impact is that people are living longer and recovering from cancer and living with and beyond cancer. When we talk about investment, that is what we are trying to achieve. Of course we want to use the resources we have in a way that will deliver the best return on our investment for all of our people. I have spent some time on this. Report after report, whether it is the OECD country cancer profile or the EU analysis, shows that Ireland is doing better beyond its European peers in its cancer performance and mortality rates.”
“I had not realised quite how high the proportion is of people who are dying from cancer. Nevertheless, I take some measure of comfort from our falling mortality rates relative to the rest of the EU and the return that we are getting on investment where more and more people are living with and beyond cancer.”
“While still too high, cancer mortality rates in Ireland are falling faster than the EU average, having fallen by 17% between 2011 and 2021, compared with the EU average of 12%. More than €105 million has been invested in the implementation of the national cancer strategy since 2017. This includes €23 million for cancer services in 2025. That investment has allowed us to recruit more than 670 new staff to cancer services. This Government is fully committed, as I know everyone in this House is, to developing and improving cancer services. Our investment in cancer services is delivering better outcomes for patients. I will arrange for a table outlining cancer cases and deaths to be provided to the Deputy. I have to say that when I first looked at the data, I was quite struck.”
“In 2013, there were just over 21,000 invasive cancer cases diagnosed in Ireland. By 2022, that figure had risen to 26,000 annually. Of course, the population grew very considerably in that time as well. That increase is in line with projections made by the National Cancer Registry Ireland. With a growing and ageing population increases in cancer cases are to be expected, with cancer being more prevalent as one ages. While we are seeing more people being diagnosed with cancer, those people are living longer with and beyond cancer. When the concurrent national cancer strategy was published in 2017, there were 150,000 people living following a diagnosis of invasive cancer. That figure has now increased to 220,000. In 2021, there were almost 9,600 deaths from cancer in Ireland. In 2013, that figure was 8,700.”
“No, it is not sustainable and that differential in money is not fair. This is why the emergency services are attempted to be covered by the HSE. We really do need to move to that new oral policy which provides fair and open access to people across every community and in a targeted way. That is about prevention as much as about emergency care. I appreciate what the Deputy has said about accidents, which is a slightly different thing, but this is about general oral healthcare. We need to focus on the implementation of that new policy, which is aligned with Sláintecare in providing care where it is needed and when it is needed at the right time.”
“The child oral health examination programme, which is delivered by HSE-employed oral healthcare professionals, is to provide examinations and treatment identified as necessary from the age of seven up to when a child is in sixth class. Emergency care is also available from the HSE for children up to the age of 16.”
“I accept there has been an issue with the DTSS and the contractors numbers, notwithstanding the increase in fees and the increase of 44,000 in the number of patients being treated, which is something. Nevertheless, our figures for contractor numbers have gone down very considerably, from 1,500 in 2019 to 813 in 2024. In Cork and north Cork those numbers have gone from 35 to 26. I accept that. The new policy is designed to try to reflect this and reform that service delivery. The new policy sets out detailed descriptions of envisaged service reforms, which are about prevention, routine and emergency care, and oral health evaluation. That reform of the DTSS will be impacted by this new policy. It sets out for the first time that there will be comprehensive modern and clinical infrastructure supporting oral care.”
“The programme for Government contains commitments to implement that policy and reform care for medical card holders. The first phase of implementation to end in 2027 is currently being finalised and it includes reform for services of medical card holders as one of several priority actions. Of course, the real differentiation relates to children and a model of prevention. Perhaps we will catch up on that in the supplementary question.”
“Those measures did improve access to care and more than 44,000 extra patients were treated in 2024 compared with 2022. I know well, however, that there are some towns with no or limited DTSS dentists who have sufficient capacity to accept new patients. In those areas local HSE services can assist patients to access a dentist, and in exceptional circumstances where emergency treatment is required, the HSE can directly contact private providers or arrange treatment to be provided by HSE-employed dentists. The Government is committed to reforming oral healthcare services through the implementation of the national oral health policy, which is particularly important for children. I might come back to that on the supplementary question.”
“Over €200 million is invested in public oral healthcare services annually. The dental treatment services scheme provides oral healthcare, free of charge, to medical card holders aged 16 and over, as the Deputy is aware. Services are provided by dentists and clinical dental technicians who hold a contract with the HSE. It is not mandatory for a dental practitioner operating in the State to hold a contract to operate the DTSS. However, it is the Government’s continued intention to support and incentivise practitioners who choose to do so, in order that medical card holders can access vital oral healthcare. In May 2022, the care available under the DTSS was expanded and the fees paid to contractors significantly increased by 40% to 60% to incentivise that across most treatment items.”
“We may need to separate the issues in the review, which we will look at and I am sure the House will look at in great detail, from the overall workforce plan for the hospital for the future.”
“I am anticipating that report but I have not received it yet. I have not been presented with it yet. Of course, I will look at it immediately. There are a number of different issues that are not the same thing. One is the report, and we will look at the issues that are particular to that. The others are the resources and the increase in the number of consultants, which is quite considerable as the Deputy is aware, and making sure that we have the best workforce plan for the hospital in the first instance and into the future. They are two distinct things and I would not like to conflate them because no matter how many consultants we have, of course, we have to make sure that every consultant and every person working in the health system is working in the correct way.”
“I am currently assessing the CHI plans to move in and what will be done on a month-by-month basis to ensure that we have delivery of the hospital for patients in 2026. At the earliest possible safe time in 2026 patients will be moved. I am assessing that pretty rigorously at the moment.”
“I am advised that there is active engagement between the HSE and CHI to further revise the workforce plan. The question of staffing in all the specialisms has to come within the workforce plan. I appreciate that between now and the opening of the hospital, we might get several such letters from different specialists who are, understandably, trying to make the best case they can for the best resources for their area but this can only be delivered within an overall workforce plan and the budget for that. While we might have different instances over time, that workforce plan is absolutely essential and that is what we have to work towards in the first instance. On the broader commissioning of the hospital, early access in April has been agreed.”
“Over the next number of years as the population grows, that must grow with it and that is our intention in an appropriate way but, for the moment, the workforce plan is there. Regarding the opening of the hospital, I am assured by the builder that we will have the building at the end of June. I received that assurance verbally when I was there last week with the Northern Ireland Minister of Health, Mike Nesbitt. I am assured by BAM that we will have the hospital at the end of June, which is what it committed to publicly in January. The hospital has advanced very considerably - even since I was there last October. We have agreed early access for CHI. I might pick that up in my supplementary reply.”
“I am advised that there is active engagement between the HSE and CHI to revise this plan to take account of further service developments and ensure the right workforce is in place to staff the new hospital. This is something that will need to be revised continually as the population grows and as we build capacity, so I anticipate that the workforce plan will continue to evolve and grow. I understand that there is broad agreement on overall numbers required and every effort is being made to bring this process to a conclusion as soon as possible. Any additional staff needed will be sought as part of the annual Estimates process in the context of overall prioritisation of available funding.”
“There is a significant ongoing programme of work to prepare for the opening of the new hospital, including integration of the three hospitals and operational commissioning. This operational commissioning includes the clinical fit-out for the entire hospital, total digital integration and staff training to ensure the hospital can open and accept patients safely and also that the workforces and cultures of the three hospitals come together. There are approximately 4,500 staff working across Children's Health Ireland. This is an increase of 26% since 2019. An extensive training plan is under development to support the transition of current staff to the new hospital. Since the definitive business case was finalised in 2017, the workforce plan for the hospital has been revised multiple times to take account of service developments.”
“I am also interested to see what flexibility GP Care For All can facilitate as well. The offer here involves structural solutions not just from the Department and the HSE but with an independent third party to try to find a solution, offer of additional resources and offer of direct subsidy. I am certainly not saying, "How much more can we offer?" but I do want to know what we can do to get this resolved because that is our intention. It cannot be that only one side is trying to work it out, however. There must be a certain measure of flexibility.”
“I do not accept that no solution has been attempted. I know it is not quite what Deputy Sherlock is saying but for the benefit of the House, proposals have been presented to GP Care For All. One is a partnership model, which is a traditional model of service delivery within general practice and also works in other areas. Another proposal is a hybrid model where the HSE contracts individual GPs to provide services to specific patients and a model around that. Another proposal is a more direct subsidy model. A few different options have been on the table. I appreciate that we have 29 seconds to work out the details and I do not wish to read it all into the record of the House but I am certainly happy to try to understand why not one of these models can work.”
“It is an area that needs GP services and support, as the Deputy and I discussed previously. We are very committed to trying to keep this service open but it will require some adjustment on both sides and we are working to find a solution. The current model will have to change a bit and be flexible in that way.”
“The Deputy set out the different options that were proposed. They were proposed in good faith with a view to keeping the service open and working. At some point, there is a finite number of options that can be proposed and try to be supported. They are really trying to work to find a solution. The Department and the HSE are ready to continue to engage with the charity regarding the proposed structural solutions. It will require some adjustment as to how GP Care For All operates or is structured but the HSE has also made a commitment to cover any funding shortfall arising from a change in the charity's operating model and to work through the implementation of the viable solutions that can be developed. More broadly, I am concerned to ensure that north-east inner-city Dublin is well served and better served by GP services.”
“Issues relating to tax administration are a matter for the Minister for Finance but I am aware that section 1008A of the Finance Act allows, under certain circumstances, for the GMS income of GPs in medical partnerships to be treated as that of the partnership for income tax purposes rather than income of the individual GP. The introduction of this section did not change how GMS income of GPs who are not in medical partnerships, such as those in the organisation concerned, should be treated under tax law. Tax treatment is a matter for the Minister for Finance. What I am trying to do is ensure that this service remains open, that it has concrete solutions that are implementable and that it gets the resource support it needs to provide the patient care I know the Deputy wants for her constituents.”
“We both want the service to continue. In addition, the HSE provided for a third party to independently advise the organisation on the matter. I understand that this advice built on the solutions presented and further developed the organisation's understanding of what implementation of those solutions would involve, including the identification of any additional costs and resources required. The Department and the HSE remain committed to engagement to ensure it can continue to provide services. That engagement includes working with it to implement the developed solutions and identify any additional supports recognising patient need in that community.”
“Following the Deputy’s question last week, and prior to that, my Department and the HSE have had extensive engagement with the organisation concerned. That engagement has focused on identifying ways the organisation can continue to deliver services, which is what we want, how it can be supported by the Department and the HSE, notwithstanding the tax treatment, and finding what other solutions are possible. Several solutions in line with tax legislation and the provisions of the Health Act have been developed and presented to the organisation concerned, which might have the opportunity to reflect on that. Those solutions identify different business models that are practical and implementable and my Department is confident they would allow the organisation to continue its operation in line with all relevant legislation and the GMS contract.”
“I know the Deputy is aware but I want to inform the House more broadly. The other lab will provide elective services five days a week and the two labs together will protect better against both emergencies and elective issues. That is a major step in what the Deputy correctly acknowledges is a long-standing need. With regard to 24-hour care, I am very open to providing the best care possible. I want to see what is in the cardiac review and to make sure we have the resources there, but I also want to ensure they are doing enough procedures to ensure that patient safety is encompassed within that. I am keen to work with the Deputy on delivering both of those things as we move to that point, while recognising that enough procedures must be happening all of the time to ensure it is a safe place to do that.”
“I could not agree more about the need for a dedicated cardiovascular strategy and the multi-annual funding to facilitate that. With regard to Waterford, I have a small update. After an extensive recruitment campaign, we now have two labs open. One of those, from 18 March, will open with extended, albeit not 24-hour, 8 a.m. to 8 p.m.-----”
“We will need to carefully consider the number, location and resourcing of emergency heart attack centres to ensure that a balance can be achieved between accessibility and the provision of safe, efficient services. Cardiovascular health is a major pillar of the health funding announced in budget 2025, which included over €9 million in full-year costs to support important cardiovascular health initiatives. As the Deputy said, the publication of this review is a precursor of that, which I recognise.”
“I cannot answer why it has not been done to date but I commit to the Deputy that it will be done and, naturally, I would welcome his engagement on it when it is published. I will be meeting the people involved when I come back from the St. Patrick's Day trip. I look forward to getting it published then because, as the Deputy says, it is incredibly important that it is done. Recent trends in the demand for cardiac services reflect the changes in population and the health needs of an ageing population, which considerably changes the profile of need. The demand for emergency cardiac interventions is declining but the demand for non-acute services, such as the management of chronic disease, is increasing and we need a balance in terms of how to deliver the best service.”
“That will take time to develop and will require significant reform to ensure effectiveness and sustainability. I am reviewing the report and I hope to meet the authors shortly. Yesterday, at St. Michael's Hospital, we met Professor Ken McDonald, who is one of the people involved, and I hope to have the opportunity to meet with them when I return from my St. Patrick's Day engagements. I would anticipate publishing it shortly thereafter.”
“The national review of adult specialist cardiac services is finalised. The review provides a detailed, evidence-driven analysis of cardiac services across the country. A wide range of stakeholders - clinical, patient and public - were consulted as part of the review. The review provides recommendations around cardiac health policy, specifically: patient-centred care integrated with Sláintecare; increased cardiac care in community settings; a focus on prevention; capital investment for non-invasive diagnostics and imaging, including ehealth; structural reform to develop regional cardiac networks and national comprehensive cardiac centres; and leadership and governance. Publication of the review, which is very important, will facilitate the development of the new national cardiovascular strategy.”
“The Senator is right that the scheme needs to be reviewed. Everything has a cost so we have to work out the broad need across the board. Not everything will be possible. I thank the Senator for highlighting that. He is right that the scheme needs to be reviewed. Was there anything else?”
“We have another really important side event, called "Women in Gaza: Rising for Freedom and Dignity", organised by the League of Arab States together with UN Women. I thank the Senator for highlighting the war crimes happening in Gaza and Ukraine in respect of sexual violence and the targeting of medical facilities. I have a meeting with Karama, a network of civil society and activist groups from the Middle East, and with Concern and have a number of other events. To highlight to colleagues what is happening on an international basis, we are increasing our overseas development aid budget and we are engaged on a multilateral basis to try to lift the experience for women around the world and not just in Ireland, although, of course, our focus starts here. Have I forgotten anything?”
“As one of those countries, I am speaking next week to the United Nations Commission on the Status of Women. It has never been a more important time to highlight women in the United Nations, especially with all the changes currently happening in diversity, equality and inclusion all over the world. I want the Senators to know what I am doing on their behalf. I have a bilateral meeting with Sierra Leone. Botswana, Malawi and Ireland are trying, as a trio, to rejuvenate this whole process and to rejuvenate the Beijing Declaration and Platform for Action on genuine equality between men and women. I have a side event, called the "Socio-economic consequences of early Pregnancy in Latin America and the Caribbean; A Call for Policy Action", where I will speak with colleagues from Panama, Costa Rica and the Dominican Republic.”
“I have been meeting him over a long period as we are trying to get the United Nations Development Programme office for sustainable finance to be based in Dublin. We have been working on this for a long time with the former Minister, Eamon Ryan, in the past Government. I am sure the Minister for Finance, Deputy Donohoe, the Tánaiste and Minister for Foreign Affairs, Simon Harris, and the Minister of State, Deputy Richmond, will be supportive of it. Mr. Neto has said Ireland is one of very few countries around the world expanding its overseas development aid budget, in contrast with many European countries. We should all remember that. While we should of course be doing that, this is in contrast to many others who are making significant cuts.”
“Cavan termination of pregnancy services will open on 31 March. Regarding pregnancy loss, we did a fair bit on this in the past Oireachtas in extending and making available statutory entitlement to leave and after 24 weeks, people are entitled to a full maternity leave. It is not much but it is some support to recognise the pregnancy. Many female Members of this House and the Dáil spoke on that. I am glad to hear the continuation of that being highlighted. It is such an important issue for - as the Senator said - one in four women. There are many in this room who share that experience and it is important to highlight that loss. Senator Higgins raised the more international piece and she is quite right to do so. I had one line in my speech on this. Yesterday, I met Marcos Neto, UN assistant secretary-general.”
“Senator Tully and I were co-chairs of the Oireachtas family carers group and during that period, the disregards for carer's allowance were extended considerably three times, for both the savings disregard and the incomes disregard. We must take this further. We all want to get to a point where there is no means test for that but we also need to look at priority. As the Senators are aware, in my own constituency and others, we deal with carers who are all doing very different things. Some are providing 24-7 care, while some are doing other things. Some carers are caring for one person and others are caring for two. There are very different measures of need in this and while the body of work is really for the Minister for Social Protection, I recognise people have very different experiences.”
“An amending Bill is needed to tidy up some of the necessary work but it is also important to get the authority established and do this all in one go within this calendar year. I should have said at the outset, however, that I really appreciate everyone's engagement and ideas because I have learned so much from all the Senators here today. There is a body of work to do that will extend eligibility a little more. Once the authority is established, it will enable same sex couples to begin accessing services. It is important when we consider where we go best on furthering eligibility, that we look to the scientific evidence of where we are likely to get the best outcomes first, rather than looking to our constituents or our hearts in the first instance. Some Senators raised the issue of carers. It is really important to highlight carers.”
“I recognise, however, there is a need for more supports. I wish to highlight and recognise the Minister of State, Deputy Butler, is doing a lot work on both adult and children in this regard. It is important to recognise that. The new children's hospital - which I visited last week - will have 20 dedicated CAMHS beds, with eight of those beds dedicated to eating disorders. This will be an important step. There will also be 14 of the anticipated 16 multidisciplinary eating disorder teams in place around the country in 2025. We have another two to do there. Regarding the pelvic floor issue raised by Senator O'Loughlin, I visited St. Michael's Hospital this morning, which has a dedicated unit that opened in December 2024. I am told it is working well in meeting some more of the need. There is a balance around the issue of IVF and AHR.”
“There is probably a no more marginalised group than Traveller women in prison. If you look at the statistics - and I have raised it again and again - Travellers are much more likely to be imprisoned, both the Traveller community in general but particularly Traveller women. It is important to recognise some of the sharp realities of life there. Several Senators correctly raised eating disorders. I met Deputy Butterly, who was here last week and spoke so eloquently on the radio about her daughter - I think her name is Jennifer, forgive me if I am wrong. I also spoke at the Bodywhys conference, which was an international conference with speakers from London and the Netherlands who provided evidence-based research on early intervention initiatives. They have been doing very interesting research.”
“I have asked my officials to try to engage with Dóchas to find ways that I, as Minister for Health, can lean in and do better for women in the prison, particularly in recognising the impact very short sentences have and in respect of the inability to support and treat people over time. Women coming in and out of Dóchas - which they typically do based on the sentences they get - means it is very hard to get any further in terms of providing supports. Two years ago, I was in the new women's prison in Limerick- and we hear all sorts about Limerick Prison. What struck me was the dentist chair there. It really spoke to me about the violence many women had experienced before they ever got to Limerick's prison for women prison and how important dentistry was as an immediate support tool to women coming in.”