Dáil Éireann debate -
Thursday, 3 Oct 2024

As the Deputy will know, the model of care for the national clinical programme for eating disorders was launched in 2018 and since I took office in July 2020, I have prioritised its roll-out. Multidisciplinary eating disorder teams for adults and CAMHS are being rolled out throughout the country. There are now 11 teams in place, comprising six adult teams and five for child and adolescent mental health services. Earlier this year, I announced the establishment of a new adult team for CHO 7, which will cover the areas of Kildare-west Wicklow, west Dublin, south Dublin city and south-west Dublin, bringing the number to 12. To date, more than 100 posts are funded under the national clinical programme. More than 80 eating disorder clinicians, including ten consultant psychiatrists, are now treating people with eating disorders. Last year, the HSE made a dedicated investment of €8.1 million under the clinical programme.

As for the Deputy’s question about CHO 3, when I was meeting all the clinicians prior to the budget, I put a heat map on the wall and we looked at areas in the country that did not have these services, and that is where my priority went in this budget. I have good news for the Deputy this morning as I am pleased to confirm that under budget 2025, I have allocated funding for a further two eating disorder teams next year, which will include a CAMHS team in the mid-west. This will bring the total number of teams nationwide to 14. CHO 3, therefore, covering Limerick, north Tipperary and Clare will get an eating disorder team for CAMHS, which will comprise ten whole-time equivalent staff. I am delighted to be able to give the Deputy that information.

I thank the Minister of State. That is fantastic news. My response was going to outline that ours is the one region that does not have a team in place, so that is significant. I appreciate that the Minister of State has prioritised this area since she took office. I put this question to her because Mind EveryBody and Cared Ireland gave a briefing in recent weeks in the audiovisual room and the lived experiences of those with eating disorders, as well as the personal consequences and impact on them and their families, struck a chord with me. I wanted to point to Ciara Greene, who has more than 20 years' experience. She has had a number of struggles over recent years. There were some awful stories, with speakers reporting that they had been told they were seeking attention. I wanted to bring that to the Minister of State's attention because it is serious and concerning.

Since the model of care was launched in 2018, we have learned that 90% of those with an eating disorder can be treated very well in the community. We saw a huge spike in the number of referrals for eating disorders during Covid, especially in girls aged 15 or 16 with anorexia. As I said, year on year I have continued to prioritise the roll-out of these teams, which are specialist teams. People who work with eating disorders have specialist qualifications, and the fact 100 people are working on a specific clinical programme for eating disorders is very welcome. I was conscious the area in question did not have a CAMHS team and it is important that that will be done. Six posts will also be allocated to the adult eating disorder team in CHO 5, my own area. There are four posts at present but a further six will be added to enhance that team.

I seek clarification. We will have a CAMHS team but I am conscious of the need for a pathway for adults to get services. Will that remain a gap to be prioritised next year?. At least 200,000 people in Ireland suffer from an eating disorder and there is an issue with the availability of inpatient beds. While the Minister of State alluded to community care, which may be fantastic for many who need it, if they need that specialised care and treatment, inpatient beds are the only place where they can get that, as far as I understand. Currently, there are only three and they are all located on the east coast. Is there any opportunity in this budget to increase the number of inpatient beds for the mid-west?

As Deputy Wynne noted, there are currently only three specialist inpatient beds for adult eating disorders in the State. As the Minister of State will know, eating disorders are one of the most fatal mental health problems people can have. Patients are being admitted into non-specialist wards, having their body mass index increased without specialist help and being released back into the community they came from, and this cycle is happening over and over again. If they are lucky, they will go back into that cycle, but sometimes people fall through the cracks, as the Minister of State will appreciate.

Will there be an increase in the number of inpatient beds in budget 2025, and if so, where will they be located?

Approximately 90% of people with eating disorders are treated in the community. The best clinical advice that was available to me when I took up this role suggested that we should enhance the clinical supports in the communities because that would meet the needs of that 90%. We are undertaking a review of the model of care because when it was devised in 2018 with data from 2016 and 2017, it was estimated that there might be 60 people a year, whereas we are now reaching more than 500 people a year who have an eating disorder, which is a serious mental health illness.

A total of €2.2 million as a full-year cost is being provided for the new eating disorder teams. They are expensive to put in place. It amounts to €1.1 million as a half-year cost. It takes between 12 and 14 months to recruit the teams and put them in place.

To respond to Deputy Ward, again I prioritised the community. What we are considering in respect of eating disorder beds will form part of the review, but I am clear that there will have to be a geographical spread.

We have three beds in St. Vincent's hospital, which serve only that particular area. It is really important that when we put those facilities in place, there is a geographical spread. We want to ensure that whichever area people live in, they have access to a bed within an hour's travel.

I acknowledge the Deputy's continued interest in this matter. The model of care in regard to dual diagnosis was launched only last year. In 2021, I launched the model of care for attention deficit hyperactivity disorder, ADHD, for adults, with four new teams in place this year. We will continue to complete that roll-out. Given the model of care for dual diagnosis was launched only last year, we have a way to go.

The model of care describes a clinical pathway based on integrated service delivery across primary care, substance misuse, community mental health services and acute services. It recommends the development of 12 adult specialist dual diagnosis teams nationally and four adolescent teams. A total of €2 million has been provided for the service to date, with recruitment for adult teams in the mid-west and Cork and adolescent teams in Dublin at an advanced stage. I have allocated a further €600,000 in budget 2025 to enhance teams and establish a further two teams. This will include the appointment of: two whole-time equivalent appointments for community healthcare organisation, CHO, 3, which will enhance the existing team; one whole-time equivalent for CHO 9, which is the substance abuse service specific to youth, SASSY, team; one whole-time equivalent for CHO 4 for Cork Prison, which will be a new and really important team; three whole-time equivalents for CHO 7, which is an adolescent team, specifically, the youth drug and alcohol service, YoDA, team; and three whole-time equivalents for CHO 5 for a new team in Waterford. This was all done based on the heat map specifying the areas that did not have services.

The Department remains committed to developing the national dual diagnosis centre at the Keltoi facility, as envisaged under the model of care. The HSE is currently looking at staff requirements and other key dependencies for the development of the service. It has indicated that a resource proposal will be submitted when the work is complete. That was not yet available when the Estimates were being done. We are working closely with the HSE. Dual diagnosis involves a complicated model. Some of the funding is provided from the drugs budget and some from the mental health budget.

I have been working on this issue since the service closed during the Covid crisis in 2020. We were told at the time by the now Taoiseach and then Minister for Health, Simon Harris, that it would be open as soon as the Covid crisis finished. I raised the matter again with the former Minister of State, Deputy Feighan, and the Minister of State, Deputy Naughton. I expected the Minister of State, Deputy Burke, to take this question today. Will the Minister of State, Deputy Butler, indicate who has responsibility for the Keltoi centre? Under which Department does it fall? When more than one Department has responsibility for something, it can fall through the cracks. The Keltoi centre plays a really vital role. As with eating disorders, which we have talked about, it is important to have an inpatient facility where people can go to get out of society for a while and access the specialist help they need. I support the model of care the Minister of State has been talking about but we need that residential provision. When will the service reopen?

I do not disagree with the Deputy. The Keltoi rehabilitation centre is hugely important. It is recommended in the model of care that the centre provide a dual diagnosis service. It is intended to be used for rehabilitation of those with serious and significant mental health difficulties and substance use disorders. It will accept referrals from across Ireland, which is really important. Access will not be limited by a postcode lottery. The service is planned as a partnership between the HSE and social inclusion in CHO 9. It will offer a dual diagnosis national clinical programme. I envisage the mental health funding certainly will come from the mental health budget of my Department. We are very much engaged in the process and have had meetings recently. Some funding will also come from social inclusion. It is something I want to see progress very quickly. The fact the inpatient rehabilitation centre will serve the whole country is hugely important.

Keltoi is a facility I know very well from my professional life before I came to this House. I know the important role it plays. I am still concerned about the funding coming from different Departments and the question of who is responsible. Where does the buck stop when it comes to reopening the residential service? The centre is back open as a day facility but the residential service is missing. In the reply to a parliamentary question of mine in April, I was told a capital submission for the project had been approved. That was welcome. Unfortunately, no funding for the project was allocated in 2024. Is funding allocated for it in 2025? It is vital that the service is reopened as soon as possible.

As the Deputy said, the day service is open. My understanding is that the submission we received was not sufficient at the time to enhance the residential element of the service. That is still being worked on, as I said, between social inclusion, the HSE and the Department of Health. I expect the mental health unit within the Department to take the lead on this. We are driving it on. That is where it should sit. We are working in partnership with social inclusion and with CHO 9. I am delighted that there will be €1.3 million in recurring funding for dual diagnosis. Ten posts will be filled this year. A dual diagnosis team is not like an eating disorders team. It does not need as many posts and the teams can be set up much more quickly. Having the ten whole-time equivalents in place certainly will enhance what we have. We are keeping a really close eye on the Keltoi service because it is an area on which we want to see progress. We have a premises and co-operation from all the different services and stakeholders. We will move on it as soon as we are ready to do so.

My question concerns the eligibility rules for medical cards and GP cards in respect of people with chronic and incurable autoimmune diseases. This is an important issue for those it affects. These are difficult healthcare conditions that come with a lot of ramifications for quality of life and in terms of costs. People need access to community healthcare at a fair and affordable price. Will the Minister look at expanding eligibility, acknowledging that this is a huge issue for those it affects?

Medical card provision is primarily based on financial assessment. In accordance with the Health Act 1970, eligibility for a medical card is determined by the HSE, which assesses each application on a qualifying financial threshold. The idea of granting medical cards or GP visit cards based on any particular disease or illness has been considered. It is a topic we discuss regularly in the Dáil. There are Deputies, for example, who have made a very reasonable case for cancer care patients. The proposal is that a cancer diagnosis would trigger eligibility for a medical card.

This issue was looked at in detail by an expert group in 2014. The group concluded that it is not possible to list and prioritise conditions for medical card eligibility without creating risks of inequity by diagnosis or condition. As it was explained to me, we cannot create a hierarchy of disease. The expert group could not find a solid ethical approach that would justify saying "Yes" to cancer patients and neurological patients, for instance, and "No" to cardiovascular and diabetes patients. The group said it just cannot be done like that. We cannot create a hierarchy whereby one disease or illness is deemed to be more worthy than another.

While I fully appreciate the Deputy's question, which is one that is discussed quite regularly in the House, the consistent position, which we should maintain, is that eligibility is based on other criteria. There is the financial assessment, as we are aware. There are a lot of discretionary medical cards given out. I might come back to that in my next response.

I see the point the Minister is making. It does not necessarily mean I wholeheartedly agree with it, but he is right to outline that. We do this best on the basis of age. I acknowledge the Department with its enormous resources has to prioritise what it feels is in the best interests of caring for the needs of our population around this expenditure and providing the best access to healthcare. However, from the perspective of somebody who has come to me and told me their story about suffering from this illness, it brings huge additional costs. I referred to one constituent in the Rathcormack area. They explained to me the flare-ups of their condition and having to travel unexpectedly to and from a healthcare facility in the midlands. It just comes across to me as being unfair and discriminatory that the State healthcare system does not step in and intervene in a case that merits that intervention. The Minister referred to the discretionary medical card. I would be delighted to speak to him individually about the case to which I have just made a brief reference. We do this best on the basis of age. I know we have just come through a budgetary process, but perhaps this is something we could reflect on for the future, broadening it on the criterion of illness as well as on that of age.

I will make two points. The first is on the discretionary cards. One in eight medical cards is discretionary, and that is meant to speak to exactly the kinds of cases the Deputy talks about. The discretionary medical card is issued to patients with big medical expenses. They might satisfy the gross income criterion but not the net income criterion. Once they have to pay all these medical expenses, they do not have enough money. That really is the purpose of the discretionary medical card. If the discretionary card is failing some people who really cannot afford their medical care or cannot pay their bills because of their medical care, we may need to review that. As I said, however, nearly 200,000 discretionary medical cards are live at the moment.

Second, the gap between having a medical card and not having one has shrunk, given the number of services we have made free or much more affordable in the past four to five years.

I know I have raised this with the Minister previously, but in that specific area around Rathcormack and in north Cork generally, people accessing healthcare services has been a huge difficulty and a huge challenge. In particular, I think of the town of Mitchelstown. I have raised here many times cases of a concentration of the healthcare resources in a primary care centre that is privately operated and run. I meet so many people in that constituency who cannot access their local GP. They have a range of different healthcare concerns, whether it is a young person suffering from an autoimmune disease or elderly people who desperately need to get a healthcare checkup. I want to raise this on the floor of the Dáil with the Minister. It may be our final exchange before the general election. This is a huge issue in north Cork for the constituents I represent and it matters to them. The people I have spoken to can be emotive about this, and they are right to be. They are angry. Will the Minister commit the Department to having a look into what is going in north Cork, including day-to-day healthcare services alongside the out-of-hours GP services?

I strongly support the sentiments expressed by the Deputy. This applies not only to north Cork but all over the country and has been raised numerous times in the health committee over recent years. The Minister himself has identified the word "discretion". The request has to be that the criteria need to be broadened to take into account the fact, as described by Deputy O'Connor and as we have described many times at the health committee, that there are people who are really under pressure, who find themselves in panic - very often older people or younger people - and who see themselves being ignored by the system. For instance, in one particular case a procedural error took place and the person is now on expensive medication and so on. That will go to court, but that does not help the person in the meantime, and that is the problem. I ask, like my colleague did, that the discretion be looked at to see if the criteria can be broadened to allow in the people whom we are talking about. The Minister knows about them better than anybody else.

Our clear goal is universal healthcare. One of the three pillars of universal healthcare is that it is affordable, so a lot of what we are doing is trying to make sure that people can access care quickly, that it is great care when they get it and that they can afford it. Any debate like this is very important to constantly reviewing and finding those patients who find themselves outside of the various criteria. It is usually by a small amount but it still causes a lot of hardship. The measures we have brought in will help. We have abolished inpatient hospital charges. They were costing families up to €800 a year We have just funded free HRT. One lady yesterday in Wicklow told me she is spending €1,000 a year on HRT. We are funding IVF. Couples were spending €7,000, €8,000, €9,000, €10,000 or €12,000 on IVF. We have brought the drug payments scheme threshold down to €80 a month. We have brought in free contraception. We have rolled out eligibility for another 500,000 people to get free GP care. What we must constantly do is identify the people whose cases the Deputies raise today to ask who are the people who still cannot afford the healthcare they need. We must constantly review our eligibility to support them.

This is a similar question. It seeks reassurance for patients who suffer from various illnesses, from scoliosis to cataracts, to spina bifida. Whether they are public or private patients, their concern is for access to treatment within a reasonable time. Do we have the facilities to treat them within this jurisdiction? My belief is that we do. Whether they are public or private, can the two share the burden with a view to delivering to the patients an immediate and rapid service?

We could do an entire Dáil statement and debate on this issue, so I thank the Deputy for raising it. The Deputy has raised several areas: cataract services, orthopaedic services, spinal care and more. As I just said, our goal is universal healthcare. One of the pillars is affordability, which we just discussed, and another is rapid access. A huge amount of what we have been doing over the past four to five years is to speed up access to care. We have a ways to go. We are probably four years into an eight-year programme of work to meet the agreed ten-to-12-week targets. That is our goal. It has been agreed right across the Oireachtas. I acknowledge the work our healthcare workers have done and the progress they have made in the past four years. Their most remarkable achievement for patients in terms of waiting times is that the average time people wait for a hospital appointment has halved in the past three years and it continues to fall. It was in excess of 13 months; it will shortly be less than seven months, and the target is that no one waits more than three months. We are well on our way to achieving something that many people said was impossible and that would have Ireland as one of the most enviable public health systems around with those kinds of waiting times.

We have to acknowledge the work of our healthcare professionals They have put in extra hours, done weekend shifts and innovated. I will come back to some of the innovations on cataract services in a moment because the reductions in waiting times in this regard are fantastic. I want to be clear, however: we have a long way to go. As I said, we are about halfway through getting to what we all want, which is that nobody waits more than three months.

The Minister's reply shows an intimate knowledge of the system and its flaws and weaknesses and so on, which we all accept. We have to strive towards universal healthcare. However, it is no good telling that to the patient who has to wait, whether it is scoliosis or whatever else. I had spinal surgery during the summer. It was not possible for somebody to say to me, "We are working towards it. We will get to it in a year or five years." That does not work.

We should select, insofar as we can, the sensitive cases such as scoliosis patients who have been on a list for too long, patients with cataracts or spina bifida cases or whatever. They all need treatment and they need it now. The problem is that we have the expertise to deal with it. I had to have the expertise, although I had to pay for it in the usual way. The expertise was there, however. Once the expertise is there, there is an obligation on the public and private health services to come together to provide the kind of service patients need at the present time by way of co-operation or otherwise.

I agree with a lot of that. To be clear, it is not the case that we are telling people things will get better in the future. I am saying clearly that our healthcare professionals have made remarkable progress already. For example, with regard to cataract services, when this Government came in, the average waiting time for cataract treatment in Dublin, in the Deputy’s constituency and in mid-Leinster, was six years. It is now less than 12 months and falling fast. Children who were referred to an eye specialist in Dublin and mid-Leinster when this Government came in were waiting two to three years; they are now waiting five weeks. Women referred for gynaecology care in Sligo used to wait four years but they are now waiting four to six weeks. We are seeing more and more examples of this throughout the country. I will come back in my last contribution to this question to talk specifically about children’s spinal care.

The Minister is aware and understands this issue. He is at the coalface of it, as are the patients. It is about bringing the two sides closer together. I am aware the Minister realises the urgency of the situation.

I know a patient who had cataract problems and was on a waiting list but could not wait because he was blind. He lived alone and he was blind. He could not drive, communicate, read the newspaper, look at television or anything. His friends, neighbours and family came together to get the surgery done privately. I asked at the time, given the situation, whether the HSE could perhaps make a contribution towards it because the patient has to pay back the money. I received an ongoing, rolling maul of a reply to the question. That is one year ago now. We need to show we are compassionate and that the kind of progress to which the Minister referred is being made. While I know it is his intention do that, we need it to happen on the ground in a way that has not happened before. There has been progress in this regard. While I am fully aware of that progress, we need more of it.

First, I absolutely do not have an issue with using private care as a short-term means to get public patients faster care. We have used the NTPF as part of our waiting list action plan for the past four years and it has been highly effective in getting public patients care. While we should be building a public health service which does not rely on private care, I have no issue with using private care for anyone who needs care urgently.

This same applies to children’s spinal services. The Deputy will be aware I was in New York and Pittsburgh recently to meet the surgical teams because we are offering care to children abroad. The reality is that the CHI service is not yet big enough. It has not transitioned yet to the dedicated spinal service we want, although there is a lot of work under way. A lot more children have been operated on and received care this year than in previous years. That number will keep increasing. In the meantime, however, we are sending children to Great Ormond Street Hospital in London and New York. I am happy to also send children to Pittsburgh and other places. I fully agree that the overriding priority must be for children to get access to high-quality care as quickly as possible.

I thank the Deputy for his ongoing advocacy and work in this area. The budget contained very good news for progress in this area. I have allocated full-year funding of €50 million for these negotiations. There would be €25 million available next year on an assumed commencement date of, let us say, July 2025. There is, however, full-year allocation of €50 million. The ask from the Irish Pharmacy Union, IPU, is a lot bigger than that, obviously. It will seek more money, as happens in negotiations but €50 million is a sizeable allocation in the context, for example, of the different ways and patient services that could be funded.

A clear process was in place in this regard. First, we needed to get recommendations on any laws that needed to be changed to enhance pharmacy practice. We received those recommendations and those laws are now in place. I thank the Deputy and others for their support in bringing that forward. We now have a legislative framework to allow pharmacists to extend prescriptions, for medicine substitution protocols and for common conditions. This will bring in a new era in the services pharmacists can provide locally. I have repeatedly said that our pharmacists are highly trained and skilled healthcare professionals who have been underutilised in Ireland for a long time. One pharmacist said to me recently that pharmacists have been waiting 20 years for this new phase. Step one was to get the recommendations, which we have received. Step two was to pass the relevant legislation, which we have done. Step three was to allocate money in the budget, which I did this week. If I asked my officials to negotiate with no money on the table, it would just be paying lip service. It would not be real. I wanted to ensure a real amount was on the table. That has happened this week.

I agree with the Minister that pharmacists are all of those things. I am sure he will agree that they are also highly trusted in the community. The great potential of unlocking more community care that is in situ and close to where people live is an aim of both the Minister and me. The funding allocation is welcome but now the negotiation fee must be addressed. Before the financial emergency measures in the public interest, FEMPI, legislation was introduced, the dispensing fee was €6. It is €4.51 now. The IPU’s ask is in and around €6.50. A total of 10% of community pharmacies are operating at a loss, as I am sure the Minister knows. Up to one third of them are struggling. He has set the Government’s stall out and he has allocated money, but now it is about the delivery of these negotiations. There is great opportunity in this regard, as he will be aware. There is an appetite among pharmacists to deliver, which will, of course, relieve pressure on our GP services and all the rest. It is something the public want. Will the Minister be able to match, or get close to, the figure the IPU will seek for dispensing fees and other fees?

It would not be helpful to set out the State’s negotiating position. What I have said to the IPU and my officials is that everything is on the table. The Government has put €50 million on the table this week, which is a sizeable amount. Of course, the IPU will say it is not enough and will want more. It is a sizeable amount, however. Everything can be discussed in the round negotiations. The IPU can discuss the fees that are currently paid and anything else.

Irrespective of the negotiation on fees, which will happen as there is a process for that now, we have provided new opportunities for new revenue streams for pharmacists. It will be a market-based discussion as to how much pharmacists want to charge for a prescription extension for a private patient, for common conditions or to prescribe oral contraception. They exist in the private market. GPs charge different amounts and I am sure pharmacists will do likewise. There will be a discussion on the €50 million allocation. We have opened up new services which will create new revenue streams for pharmacists, at least for the private patients attached to them.

I have also committed to undertake a root-and-branch review of the bureaucracy and the red tape in order to cut the red tape to make it easier for pharmacists. This will reduce the operating costs and the hassle for the pharmacists as well

A lot of the discussion among pharmacists concerns the volume of administration and paper-based work they must do. We had a debate last week – I brought this issue up in my budget discussions - about the move towards electronic health records and, more generally, towards an e-health model.

We need to see that in the pharmacy sector as well. Pharmacists operate in a private retail environment but I am talking about the public side of their model. We cannot just say they will always get a few bob from selling deodorants, packages, non-prescription medications and all the rest, because that is not necessarily a given. They are competing with others. I see very many over-the-counter medications in the aisle of the supermarket and I can look past look past a pharmacist's till at those same medications. Is it right that they are being sold in a supermarket and a pharmacist's at the same time? There are threats on the private retail side as well. We have a great opportunity to move forward positively because pharmacists can unlock care in the community that could ease pressure on GPs. That is where I am coming from in this area.

As the Deputy said, pharmacists are highly trusted and skilled. They did an incredible job during the Covid pandemic. There was resistance to expanding their scope and that is why it has not happened in a very long time. I do not subscribe to this thinking. Expansion will make a big difference to ordinary punters in the community in that they will not have to go to a GP with minor ailments, such as eye conditions and rashes. Rather, they will be able to get certain prescriptions from pharmacists and have them extended. This is obviously an opportunity for the public and also one for pharmacists in terms of new services. In this regard, I have said there is significant money on the table. There is also a good opportunity for general practice because what is being done will take some of the pressure and lower acuity work off GPs.

One of the things we have committed to doing as part of cutting the red tape is getting rid of the dot-matrix printers, which may have been invented sometime in the 1700s, fired with coal and powered with steam. Pharmacists will be very happy to see them leave their premises.

Once again, I take the opportunity to raise a constituency matter with the Minister. It relates to Youghal, County Cork, my home town and new capital developments there. I am really delighted with the progress that has been made under the HSE capital development plan. I worked very hard with the Minister and Minister of State, Deputy Butler, on delivering a new community nursing unit and a new primary care centre in the town. However, is there is an opportunity to deliver a new ambulance training college in Youghal at St. Raphael's or another location in the town. The Minister knows this project is important to me, the town and the people I represent. Youghal desperately needs government investment. The training facility is a key one that could bring employment and it is much needed in a community that both wants it and desperately needs it.

I thank the Deputy for his powerful and relentless advocacy of healthcare services for the people in his constituency, including Youghal. He has raised the ambulance training college with me probably every week over the past few years. I am delighted to be able to confirm in the Dáil today that the St. Raphael's site in Youghal is the preferred location for the permanent ambulance training college. That will be very welcome news to the people in Youghal. The facility will be wonderful for our National Ambulance Service and Youghal.

The service trains the majority of its paramedic workforce through its own college, the National Ambulance Service College. The BSc paramedic studies programme is a three-year programme delivered through the college, and the college runs it in conjunction with its academic partner, UCC. The BSc programme is taught out of three NAS college campuses, located in Tallaght, Ballinasloe and Tullamore. The NAS currently has capacity to teach around 200 student paramedics every year. Last year saw 196 students accepted into the programme, which was fantastic.

The ambulance service has plans to establish a fourth campus, which is the one the Deputy and I have spoken about many times. It is to be located in Cork and is to increase recruitment capacity into our National Ambulance Service. A project to develop the fourth training campus in Cork is included in the 2024 HSE capital plan. I allocated funding for it this year to be progressed under the plan. New funding announced as part of budget 2025 will see a very significant additional allocation to the National Ambulance Service, which I might come back to in a later response.

I welcome that. I am delighted there has been progress since we last spoke about this matter. I met the Minister in his office with departmental officials about this, and it is something we have been working on together. Youghal, as a town, has taken a hammering historically. There were 4,000 people directly employed in traditional industries there and Kodak flash cameras were made there. The town has really been a victim of time, poor government investment and a lack of strategic thinking, and its people feel abandoned. As their representative, I do not blame them for feeling that. This is why decisions like that just discussed in the Chamber matter. They matter to people in Youghal and certainly matter to me as their representative because they are about having government-led investment into the community. This goes beyond healthcare; this is about the State helping a disadvantaged community, a disadvantaged area. The proposed facility, above all else, would be greatly welcomed in east Cork and, indeed, on the other side of the River Blackwater in the area of the Minister of State, Deputy Butler, in County Waterford. It would be very beneficial to the region. Could the Minister give me an insight? Could he visit the location and see the facility at St. Raphael's for himself to try to drive this on as quickly as possible?

I would be delighted to join the Deputy in Youghal and very happy to look at the site. The ambulance service is working with HSE estates to identify an interim solution for 2025 because we want this up and running. That is good news because it means the HSE can begin hiring the staff. We have a preferred site, St. Raphael's, and there is a final process and work that goes on; however, critically, the ambulance service wants to move with an interim solution right away.

In the budget this week, I allocated an additional €16 million in full-year funding to the National Ambulance Service. I spoke to the head of the service, Robert Morton, about this and noted the service is very happy with the level of investment. It means more paramedics, including more advanced paramedics, more student places and quicker response times.

I acknowledge that the ambulance service is exceeding its own targets. We have had many debates in this House in which it was said the service was getting better and better and closer and closer to its targets. It is now exceeding its response-time targets. It is not all perfect because there are cases in which people do not get an ambulance quickly enough, but I credit the service on getting better and better and more and more responsive. The new training college in Youghal, County Cork, will make a big difference.

I am very pleased with that information. I am delighted to hear that the Minister will be in Youghal and about the difference the capital development will make.

I recognise the contribution the ambulance service makes to our community. It is under huge pressure, as its staff tell me. Above all else, the new facility will bring a new generation of young people into the service, making a difference for the entire region. Youghal will be a very worthy home for it. Beyond the election, I believe it is important that the Minister get to Youghal to see the site for himself. I know he is committed to coming down in mid-October and he will be very welcome when he does so. Towns like Youghal need support from the Government. They have taken on a heavy burden, whether through IPAS accommodation or the lack of industry and investment. That is why it is important that the Government responds through capital plans such as that of the Minister and his Department, bearing in mind how we can deliver and improve upon services in these areas and the congregation of State investment in education. This is just one key example of how it could work so well.