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Dáil Éireann debate -
Wednesday, 3 May 2023

Vol. 1037 No. 4

Ceisteanna ó Cheannairí - Leaders' Questions

Ashbourne Community School is with us in the Gallery. It is very welcome.

As we speak, hundreds of nurses are meeting in Killarney in the middle of a prolonged and ongoing crisis in our hospitals. The health service is on its knees and has been for many years now. There is overcrowding on our hospital corridors, waiting lists are out of control and staff are exhausted and demoralised. Healthcare staff are at their wits' end. They have been crying out for support, but so many feel abandoned and let down by the Government's failure to get to grips with the crisis in our healthcare system. Yesterday, 704 people were lying on trolleys as they waited for care. Today, 712 people lie on trolleys. This was a predictable surge following a bank holiday weekend. In fact, this has happened on each one of the five bank holidays we have had this year. It could have been predicted and planned for.

The factors that sustain the overcrowding crisis are clear. We still do not have enough beds in the system and there are not enough staff to service those beds. Experts have warned how dangerous this is in terms of patient safety. We can add to this the chronic lack of community recovery beds, hundreds of delayed discharges and a crisis in GP provision. This means patients do not get seen when and where they need to and end up in overcrowded hospitals. Poor planning, poor leadership and a lack of investment have crippled the healthcare system. It is patients who are left to pay the price. Hard-working staff are demoralised, are trying their best day in and day out and are leaving the system in significant numbers. In fact, the Irish Nurses and Midwives Organisation, INMO, has warned today that three out of four nurses it surveyed have considered quitting their jobs. That is an extraordinary and astonishing figure. What is the response of the Taoiseach to that? I suppose we might say it is no wonder given the pressure they are under because crisis has become the norm on the Government's watch. It is the new normal that patients and staff are subjected to every day. People at their most vulnerable are left on trolleys or languishing on waiting lists and often miss crucial care. This has not happened by accident, but because of Government failure to invest sufficiently in healthcare capacity and staffing over the past decade. The response of the Government has consistently been far too slow. It is often big on promises but very short on delivery.

Cuireann géarchéim an róphlódaithe sna hospidéil othair i mbaol. Tá altraí ag obair thar a bheith crua cheana féin i gcúinsí thar a bheith deacair. Theip ar an Rialtas acmhainní a chur ar fáil go tapa agus is é sin atá ag croílár na faidhbe. Persistent and growing hospital overcrowding can be solved, but only with a multi-annual capacity expansion plan, for which Sinn Féin has called for some time. It could make a real difference to patients and workers.

There are considerable challenges but a big change could be made, with determination and the will to deliver real and meaningful difference. When will the Government support and resource hospitals to reach safe staffing levels in the short term? Will the Minister for Health publish a multi-annual capacity plan, including bed targets and detailing how he proposes to deliver the staff needed to tackle overcrowding? I ask the Taoiseach again for his response to that INMO survey and the reported finding that three out of four nurses surveyed have considered quitting their roles. How much worse does it have to get before the Taoiseach's Government gets its act together and gets to grips with what is a very real crisis?

I thank the Deputy for raising the important issue of the various challenges that affect our health service. As somebody who has worked in the public health service for seven years and has served as Minister for Health and as Taoiseach, I am not in any denial about the challenges faced by patients or staff in our health service. There are certainly too many patients waiting too long to see a specialist or get the procedure that they need. We have a chronic problem of emergency department overcrowding. However, we should not ignore the many very good things about our health service. I am disappointed the Deputy could not find even ten or 20 seconds in her remarks to acknowledge some of the successes of our health service and some of the high-quality health services provided by our healthcare professionals, including our nurses and midwives.

We have now, in Ireland, the longest life expectancy in the European Union. The young people who are here from Ashbourne Community School are likely to live longer than anyone else in the EU and that is in part down to the quality of our health service. People face real difficulties getting access to it, but there is real quality and there are very good patient outcomes once people access it. We have the highest life expectancy in the EU. We should be proud of having achieved that as a nation. I am sorry the Deputy was not able to acknowledge it.

We have dramatically improving outcomes for patients when it comes to stroke, heart attack and cancer, outperforming the NHS both in Northern Ireland and in Britain on patient outcomes and doing so by quite a distance. We are now seeing waiting times fall. We set out very clearly in the Sláintecare report that nobody should wait more than ten to 12 weeks for an operation he or she needs, or to see a specialist. It varies from month to month, but the number of patients waiting for longer than ten to 12 weeks has been coming down, whereas in most countries we have seen that going up. I think that is significant. We anticipate the number will fall further this year. We are also making real improvements on affordability, especially as it relates to reducing the cost of medicines, free contraception, expanding GP visit cards and bringing in funding for IVF this year. Thus, real change is being made in affordability.

The Deputy mentioned the issue of capacity. We have a capacity review. It has been published already and we are implementing it. Since this Government came to office, approximately 1,000 additional hospital beds and hundreds of additional community beds have been added to the system. They are needed because of our rising population, our ageing population and all of the new treatments that are now available to our patients. We have more people working in our public health service than ever was the case before. That includes approximately 6,000 more doctors, nurses and midwives since this Government came to office. There is a very real challenge in recruiting and retaining staff, but we are increasing the number of staff we have, including front-line staff such as doctors, nurses and midwives, every year. That is what the Government is doing and we are continuing to develop and improve on that plan as the years go on.

The Taoiseach should not try to hide behind the excellence of healthcare workers to try to deny the failures of his Government. I direct my comments to him and his colleagues in government. Yesterday, we had 704 people on trolleys and today, we have 712 people on trolleys. A survey has revealed that three quarters of nurses surveyed stated that they have considered leaving their posts. The Taoiseach has acknowledged that we have considerable pressure in the system and massive shortfalls. By the way, the Government has consistently fallen short of the targets it has set for the delivery of beds.

The Taoiseach has described the problem; I am now asking him to describe his solution. I again ask him to respond to that survey finding, and to the very clear low morale and real pressure that nurses, midwives and others are experiencing in the health service. I ask him to set out whether the Government is prepared to publish a multi-annual plan for beds, but also for personnel and staff to deliver those beds.

I have only seen the media reports of the survey the Deputy mentioned. I have not had a chance to read it yet. My understanding from what I was briefed on earlier is that it relates to three out of four staff having considered at some point leaving their work area, not necessarily their profession, which is obviously a different thing. However, I acknowledge that we need to continue to improve terms, conditions and pay for our healthcare staff, including our doctors and nurses. We have a pay deal which was ratified by a large majority by the nursing unions. No doubt we will begin discussions on a further pay deal to come into place later this year. As I outlined, we are increasing staffing. We have more than 6,000 more nurses, midwives and doctors in our public health service than was the case when this Government came to office and we will continue to do that. The Ministers, Deputies Coveney and Harris, have met representatives of the INMO and are working with them on changes we can make around safety in the workplace, which is really important, and tougher sentences for people who abuse our front-line workers.

The Deputy has many criticisms. She never acknowledges the success of our health service and the things we achieve in our health service. She never puts forward any solutions. I am not surprised that she does not because north of the Border, where her party has been in office-----

It is important that the Deputy hears it.

Those in Sinn Féin do not want to know anything.

They do not like the truth.

It is important that Deputy McDonald hears it because north of the Border her party has been in and out of government for nearly 20 years, and has held the office of finance minister, health minister and joint Head of Government on regular occasions. I would take the patient outcomes and the performance of our health service down here anytime over those in Northern Ireland-----

Tell Rishi Sunak that.

-----where patient outcomes are worse, waiting lists are higher and staff get paid much less.

Tell the British Prime Minister that. Tell your Tory colleagues that.

On Friday we learned that homelessness figures have risen yet again to almost 12,000 people, which represents a 2.1% increase month on month. These figures relate to the period just before the lifting of the eviction ban took effect. I shudder to think what the figure for next month will be, as the evictions allowed to proceed by the Government come into force.

These figures show that the Government is divorced from reality, detached from reality. In light of consistently rising homelessness figures - rising yet again last month - the Government made the indefensible decision to lift the temporary no-fault eviction ban. By doing so, it chose to pull the rug out from under families and individuals who are facing homelessness. It fails to understand that each of these numbers also represents a life - the life of a child living in uncertainty, a parent trying to keep a brave face or an elderly person living in fear. These new figures do not even begin to capture those in hidden homelessness, those who are couch surfing, adult young people living on in childhood bedrooms and the thousands who are emigrating for lack of affordable housing.

Having one family in homelessness is one family too many. It is even more so the case when we know how inappropriate emergency housing and hotel stays are beyond a couple of nights. Week in and week out, children are getting ready for school in hotel bedrooms and students are preparing for junior cert and leaving cert State exams, not knowing what home they will be going back to. They are being failed by the Government, and that is a national tragedy.

The Government could have used the period of the eviction ban as the breathing space to allow for the introduction of emergency housing measures, which would have provided support to families then facing eviction. However, the Government instead saw it only as an opportunity to kick the can down the road. Days before the ban was due to be lifted - and even in the days immediately following its lifting - there were no concrete plans in place to support the thousands facing eviction and about to become homeless as the ban was lifted. The Government’s mini budget, announced last week, was a desperate attempt to mitigate a crisis for which it has no one to blame but itself. These 11,988 people in homelessness deserve far more than what the coalition of convenience has offered.

They have been left behind, out in the cold, while the Government's mini budget simply puts more money in the pockets of private developers.

We in the Labour Party have consistently advocated for State-led, local authority-led, approved housing body-led solutions to the housing crisis but we have yet to see our constructive proposals taken on board. Instead, the Government has retained a failed private developer-led model and it has failed to live up to the hype it has created around housing. Its shocking failure to control the controllables is a disgrace. Will the Taoiseach reinstate the eviction ban? Will it adopt the Labour Party's constructive proposals to begin the pathway for families and individuals to safe, secure and affordable housing? Will the Government take on board the measures we are proposing to do that?

I thank the Deputy. As I have often said before in this House, homelessness is a stain on our society. As a Government, we are honour-bound and duty-bound to do everything we can to reduce the number of people who are required to stay in State-provided emergency accommodation over the next months and years. We had a period when we were able to bring it down by 30% to 40%, but it has gone back up again. We are going to take the action that is necessary - it has to be action that is effective - to bring those numbers down again.

As the Deputy has pointed out in her remarks, the temporary winter eviction ban has ended. For five out of the six months in which it was in place, the number of people in emergency accommodation rose. Unfortunately, it did not bring down homelessness, which continued to increase while the eviction ban was in place. That points to the fact that there are many other factors at play when it comes to homelessness and the number of people who are in emergency accommodation. These factors include family breakdown, which is one of the biggest causes of homelessness, and of course the spill-over effects from migration.

We have seen a further fall in the number of people sleeping rough on our streets. That, at least, is a positive thing. There are fewer than 100 people sleeping on the streets of Ireland at night. When this figure is studied, it is found that one third or 40% of those had accommodation but did not take it up for various reasons. Such reasons can be complex.

On solutions, I say to the Deputy that we are not as far apart as she may think or may wish to think. Many of the things she proposes, with the exception of the temporary eviction ban, are things we are doing. We are investing in social housing. More social housing was built in this State last year than in any year since 1975 and we will build even more this year. It is probable that one in three homes built and provided in Ireland is in some way provided by the State or its agents. That is not a small proportion. Approximately one third of the 30,000 new homes are being built in some way with the help of the State through local authorities, approved housing bodies, leasing, the Land Development Agency, LDA, and all of the different mechanisms we use.

We are also tooling up and ramping up the tenant in situ scheme. When a landlord is selling on, as they sometimes need to do for various reasons, the local authority can come in and buy the house. Approximately 1,000 of these purchases are being transacted at the moment, which is significant. We have said to the local authorities that the resources are there and they are willing to put in more funding if needed. We are tooling up the LDA to expand its affordable housing and cost-rental programmes to help those who do not qualify for social housing but still cannot afford to buy or rent a home of their own.

I agree with the Taoiseach. I think he is right. Of course homelessness is a stain on our society. It is shameful that we have nearly 12,000 people in homelessness at a time when the country is running very significant budget surpluses, with a surplus of over €5 billion last year. I disagree with him, however, on the eviction ban. We have heard from all of those working with people who are homeless that the homelessness figures would have been much worse had it not been for the existence of the temporary ban. It should not have been lifted when it was, in the absence of measures to support families and households facing homelessness.

We in the Labour Party have supported Government measures when they have been effective to prevent homelessness and to increase housing stock - of course we have - but the reality is that the Taoiseach's Government has done too little and has failed the families who are now in homelessness. It is also failing the workers. The month of May is a time to celebrate workers and workers' rights. The housing crisis is a workers’ rights issue, as we are hearing from the nurses' union today. We have recruitment and retention challenges across healthcare, construction, hospitality and all other sectors. The housing crisis is a major contributor to that.

Will the Government accept the Labour Party's constructive proposals? I refer, for example, to the National Minimum Wage (Inclusion of Apprentices) Bill 2023, which will be debated tonight in the Seanad. This Bill, which has been introduced by our Seanad Whip, Senator Marie Sherlock, would provide apprentices with higher levels of pay and attract more people to work in construction, thereby helping us to deliver more housing, which is a measure the Taoiseach and his Government want to do.

Here is a constructive proposal from us, a simple measure that could be adopted and accepted by the Government to help alleviate the housing crisis.

The Deputy mentioned the fact that we have a budget surplus, and we do. We also have the biggest budget for housing in the history of the State. If it were a matter of money and budgets, this problem would have been solved a long time ago. There are many other constraints and she rightly pointed out that one of the constraints is the availability of labour and construction staff to do all the work and building we need to do, not just houses, but schools, metros, wind energy and so on.

The Bill the Labour Party has tabled is a positive contribution to this debate. We have asked the Low Pay Commission to examine this and will propose a timed amendment to the Bill to allow proper consideration of the matter by that commission. There is merit in what the Labour Party is putting forward: that paying apprentices better might mean we have more apprentices, which in time will allow us to build our construction capacity. I welcome the party's suggestions in that regard.

For the past two weeks, Cork city’s firefighters have taken limited industrial action and protested outside the city’s fire brigade headquarters for half an hour each day. They are highlighting the fact that since the city’s boundary extension in 2019, they are required to serve an area five times the size with double the population, with the same number of full-time staff and fewer fire trucks – three instead of four.

I believe that this is a health and safety issue for every man, woman and child in Cork city. It may not have led to loss of life yet but it certainly has led to terrible situations. For example, on 28 February, the stretched fire services were attending a fire in Glanmire when a call came through about a house fire in Ballincollig. It took the brigade more than 20 minutes to reach the Ballincollig fire. The house was totally gutted, yet three minutes away from the gutted house was an empty fire station. Ballincollig fire station has been empty for several years because Cork City Council has failed to staff it. The council has advertised for retained firefighters to staff Ballincollig for two and a half years but in this time it has not filled a single position. It may be possible to recruit retained firefighters in small rural communities, though clearly the wages will need to be raised. However, in urban areas the requirement to be able to report for duty within three to five minutes is not realistic and there are no takers. Cork city firefighters have volunteered to staff Ballincollig and bring the fourth fire truck into play while the council recruits more staff, be they full-time or retained, but for more than two years now their offer has been spurned.

This is not just a local issue; it is an extreme example of what is happening in other areas too. The opening of the Stardust inquest underlines the devastation that can be caused by fire. The State has a responsibility to protect life. I do not know whether the Cork city fire chief has sent a new section 26 plan to the Minister. Perhaps the Taoiseach will clarify but he should not stand idly by while a tragedy is waiting to happen in the second-largest city in the State.

I have two questions. Does he accept there is a crisis around the recruitment and retention of retained firefighters and the State needs to step up recruitment of full-time staff? Last but not least, does the fact that firefighters feel the need to protest publicly in uniform give the Taoiseach any sense of concern about the unfolding situation in Cork city?

I thank the Deputy for raising this important issue. I was aware of the protests when I visited Cork last week. This is a live issue and, because it is an industrial relations matter, I am limited in what I can say in the House. I understand Cork City Council has invited SIPTU to talks with a view to finding a solution to the dispute and remains available to meet staff representatives. The city council is also engaging with the Workplace Relations Commission, WRC, which is the Government office often used to facilitate resolutions to disputes such as this.

The Government stands ready to intervene through the WRC should both sides be willing to do that. We strongly encourage all parties to use the established industrial relations machinery of the State to solve this dispute. I am told negotiations are ongoing with unions and representatives of the retained fire service. It relates to rostering, pay and conditions and recruitment. All of these are on the table. I know the Minister for Housing, Local Government and Heritage, Deputy Darragh O'Brien, is actively involved in this and hopes it can be concluded by the summer.

I note in passing that tomorrow is the final day in the ballot for industrial action by staff at the National Ambulance Service. Like the firefighters, they face a crisis in recruitment and retention. The new grades and pay rates agreed in their review need to be implemented now.

On the issue of the Cork city fire services, the mantra from City Hall just is not good enough. Cork City Council has told SIPTU it remains available for talks. What is the point of talks unless there is something to discuss? For more than two years the firefighters and their union representatives have been waiting for Cork City Council to put something on the table that can be discussed. There is no point in having talks about talks. The retained firefighters will keep a close eye on the situation. Real progress needs to be made and there needs to be real pay increases for those workers.

I reiterate this is a health and safety issue for every man, woman and child in Cork. The area has doubled in population and is five times the size of that previously covered, with fewer resources for the fire service. This is unacceptable and needs to change very quickly. The Taoiseach has not heard the last of this one.

We published the retained fire service review. It went to Cabinet only a few weeks ago. Approximately 1,000 submissions were made, including many from the retained service. As a point of context, it is worth pointing out once again that we are very close to full employment in this country with 2.6 million people at work. This is more than ever before. We have more public servants than we ever had in the past. Recruitment and retention challenges exist across our economy, in the public sector and the private sector and in well-paid and highly paid jobs. Everyone is struggling to recruit and retain staff in the context of full employment. It is not necessarily as simple as increased wages resulting in more staff being available. It requires much more than that, particularly with regard to making sure that we have enough people trained and educated to do the jobs we need them to do and that we are able to bring people in from abroad if they have the skills that we need.

I am rather sorry to see Deputy John Paul Phelan announce his departure from the House. I wish him and his domestic constituency the very best. I have a good deal of sympathy for his predicament. Like Paudie Coffey, Michael D'Arcy and John Deasy before him, genuine embarrassment was felt to have made electoral promises that simply evaporated at the Cabinet table. For all the blather about public spending procedures and processes, cost-benefit analysis and business plans, capital spending appears to follow Ministers' whims, largely in Dublin but in this Government Cork has had a good haul too.

It is well worth looking at the Department of Public Expenditure, National Development Plan Delivery and Reform's capital tracker to see this in action. My region is not alone. Voters in large swathes of Ireland, particularly the midlands and north west, appear to have come to the same conclusion. Fairness does not extend to the Cabinet table. This is why Deputy Róisín Shortall walked out of the Government in 2012, sickened by a Minister nabbing two primary care centres for his own bailiwick. No wonder the hospital groupings have proved unstable and, indeed, detrimental in Waterford's case. They continue to corrode progress on the development of Sláintecare. It is why Dublin's Grangegorman campus got the nod while Waterford's Carriganore campus remains in fields. It is why a 24-7 service was delivered in Limerick by a bountiful Michael Noonan but was stymied in Waterford. It is why public-private partnership, PPP, construction contracts to deliver academic teaching buildings in Technological University Dublin and Munster Technological University lashed on, yet those in the south east are still in the vortex of process, plans, procurement and, to paraphrase President Biden, whatever malarkey you are having yourself. Three programmes for Government have been treated like an à la carte menu by the alikadoos of Dublin.

No wonder the likes of Deputy Phelan are heading for the door.

This year, €12 billion will be spent on capital projects in the name of Ireland. Dublin is less than one third of this country but it will chow down on two thirds of the spending, the same as it ever was. When I challenge the Taoiseach or members of the Government on this expropriation, I am the one accused of being the parish pump politician. I am afraid that if the Department of Public Expenditure, National Development Plan Delivery and Reform's capital tracker is to be believed, the parish pump artisans sit at Cabinet. They are the ones who refuse to share out the fruits of our Republic. It is not the Mexicans who are stealing Ireland's regions’ futures. It is €12 billion this year and €165 billion by 2030. Some 8.9% of the population live in the south east. There is not a hope in hell that we are seeing more than 3% of this money, and the same goes for the midlands and the north west.

Waterford and the south east are still waiting for basic investment in our hospitals, airport, ports, the N24 and N25 and our single university. It is time to deliver something - anything. Without a fair share of capital investment, the losing regions are being left to stew in their own anger. If that anger is not remediated, it will find its voice come the next election.

It is absolutely the job of every Deputy to fight their corner for their county and for their region, and I do not have any difficulty with the Deputy doing so, but it is worth putting on the record of the House the considerable investment that has happened in the south east under this and the previous Governments, and investment that is ongoing and to come, for example, the long-awaited North Quays development now under way. More than €200 million worth of taxpayers’ money is being invested in that project, building a whole new quarter for Waterford city, one that will help to transform the city into an even larger population centre and business centre for the south east. I am really glad that is finally under way.

There has been considerable investment in University Hospital Waterford, one of the best performing hospitals now in the country. It is under a lot of pressure now because of Wexford hospital but that will pass, and it will be back to performing the way it was until recently. There is also the Dunmore Wing, the second cath lab and, of course, more investments to come. I know the Deputy has engaged with my office on that and we are working on further investment for the hospital.

The long-awaited university for the south east now exists in the form of the South East Technological University. We are purchasing the Waterford Crystal site to make sure we can expand student services further in Waterford. As for the engineering building, we anticipate having approval on that this year and I am very keen to make sure it is over the line as soon as possible.

We have also seen considerable investment in the road network in the south east. There is already a very good road between Dublin and Waterford and we have upgraded the road in New Ross, for example, and the Enniscorthy bypass. In addition, one of the biggest investments taking place in the State is going to be in the south east as well, and that is Rosslare Port, again with more than €200 million approved by the Cabinet only the other day to build up that port and to invest in it for the future.

I am also seeing a huge amount of private sector investment in the south east that really encourages me, and some big job announcements, for example, in Kilkenny city, with nearly 1,000 multinational jobs announced in the last year or so, and something similar in Waterford city as well. It is only fair to put on the record of the House that a huge amount of public and private sector investment is going into the region and I believe there is more to come.

In relation to the airport, we have made a commitment to fund the airport so we can have flights between Waterford and Britain again. I want that to happen. The deal was that we would match the funding from the private sector. Now, the cost of the project has gone up again. It is not unusual for that to happen but there has to be an engagement now as to whether we can find more money from both the public purse and the private purse to make that development happen. It is one I am very keen to see happen.

The Taoiseach has reached back into a couple of previous programmes for Government. The North Quays, as he knows, was included back in 2014, to be fair, and it has taken until 2023 to get that approved.

Deputy Mary Butler got it done.

Beyond that, the PPP for our engineering building in Waterford Institute of Technology was actually granted planning permission in 2008. In 2020, I had the pleasure of coming into the Government here to see that project sidestepped while other PPP projects in Cork and Dublin, to the tune of €330 million, were advanced. This is what I am talking about.

The Taoiseach said we are under pressure in Waterford hospital at the moment. I was down there the other day for a ten-year project to move community services out of it. We could only manage to put out a tender to put a roof on a building, and we did not decide to even try to get the building developed so we can move out to get these beds that we need. At this juncture, we do not have a solution to extend the cardiac service because we do not have a dedicated beds solution.

I asked the estates section and I asked the Minister about supplying modular refits to get that done but that is not on the agenda. To be fair, I hear what the Taoiseach is saying about some type of levelling up but we have a long way to go to get there. The capital tracker shows the delay and the lack of funding. We have 9.8% of the population but we are not getting 9.8% of the capital funding.

I share the Deputy's frustration about the fact that so many infrastructure and capital projects take time to come to fruition and I can guarantee that it is not unique to the south east. I will not embarrass myself by listing them, but all of us from Cork and Dublin can tell the Deputy about capital projects in both counties that we would have liked to have started a long time ago but which, for reasons beyond our control, were delayed. That is just one of the realities that we face, although the new planning and development Bill will help to change that, making sure that fewer important infrastructure projects get caught up in the planning system and then subsequently get caught up in the courts.

In terms of where we are when it comes to investment in the south east, the Deputy has my assurance regarding a number of projects. The North Quays project is under construction and we will get it finished. We will get new homes, new businesses, retail units and everything else built there. When it comes to University Hospital Waterford, we will have the second cath lab up and running this year and there will be further investment in that hospital. When it comes to the South East Technological University, we are going to make sure that the Waterford Crystal site is brought into public ownership and that the engineering building is contracted and under construction within months. That is the commitment I make to the Deputy in the House today.

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