Written Answers Nos. 1317-1336
1317. Deputy Colm Burke asked the Minister for Health if he will consider the formation of a minor ailment scheme implementation project group, with the view to enhancing services provided by community pharmacies (details supplied); and if he will make a statement on the matter. [12929/23]
View answer1318. Deputy Colm Burke asked the Minister for Health if he will consider the addition of medicines listed in Schedule 8 of the Medicinal Products (Prescription and Control of Supply) Regulations 2003, as amended, to allow for a greater number of ailments to be treated through a ‘minor ailment scheme’ in a community pharmacy setting; and if he will make a statement on the matter. [12930/23]
View answerI propose to take Questions Nos. 1317 and 1318 together.
As Minister for Health, I recognise the significant role community pharmacists play in the delivery of patient care and acknowledge the potential for this role to be developed further in the context of health service reform. Their participation in the national COVID-19 vaccination rollout – the largest ever undertaken by the State – and in the recently launched free contraception scheme are examples of the importance of their role in the functioning of our health service.
On the 24th of November 2022, I, along with Departmental officials, met with a delegation from the Irish Pharmacy Union. At that meeting, various proposals regarding extending the scope of practice offered by community pharmacists were discussed. These proposals – including that regarding the implementation of a minor ailment scheme – are currently under active consideration by the Department. As you will appreciate, the implementation of any such scheme necessitates prior engagement with a range of stakeholders and full consideration of all the relevant legislative and operational issues involved.
Of course, any publicly funded pharmacy service expansion should address unmet public healthcare needs, improve access to existing public health services, and provide better value for money.
1319. Deputy Colm Burke asked the Minister for Health if he will consider the expansion of medicines noted in Schedule 8 of the Medicinal Products (Prescription and Control of Supply) Regulations 2003, as amended, to include the full range of oral hormonal contraceptives and injectable long-term contraceptives (details supplied); and if he will make a statement on the matter. [12931/23]
View answerAs you will be aware, and by way of context the free contraception scheme was launched on 14th September 2022, and is currently open to women aged 17-26 who are ordinarily resident in Ireland and will be extended to women aged 30 and under by September 1st, 2023. The potential to make some forms of prescription contraception available through pharmacies, without prescription by medical practitioners, was considered as part of the work of the Contraception Implementation Group and is wider than the free contraception scheme.
In Ireland at present, accessing oral contraceptives is regulated and requires a prescription from a medical practitioner in accordance with the requirements of the Medicinal Products (Prescription and Control of Supply) Regulations 2003, as amended. These regulations apply a comprehensive system of control to medicinal products and identify those products which may only be supplied on medical prescription, and also specify the circumstances excluding medicinal products from prescription-only control. Schedule 8 to the regulations lists those medicinal products which may be supplied and administered by pharmacists pursuant to regulation 4B, where that pharmacist has completed approved training regarding the administration of such products and the management of any adverse reaction.
In order to enable pharmacists to supply the specified products alluded to in your question without the need for a prescription, detailed clinical consideration is required in the first instance to ensure that various patient safety issues are fully respected. Following previous engagement with representative groups, my officials at my direction, are currently engaged in a process, which includes obtaining recommendations from relevant clinical experts within the HSE as to the clinical appropriateness of making some forms of currently prescription controlled contraception, available through pharmacies without the need for a prescription. This process is ongoing.
Thereafter, and with due consideration of the policy position adopted and underpinned by appropriate clinical recommendations and advice, the modality of giving effect to this decision will be considered. Any mechanism introducing this change, or indeed giving effect in a given instance to any other policy decision, must be robust, appropriate in the given context, and legally sound.
1320. Deputy Colm Burke asked the Minister for Health the proactive steps he will take to address the management of medicinal shortages, and to ensure the ongoing continuity and security of Ireland’s supply chain; and if he will make a statement on the matter. [12932/23]
View answerMedicine shortages are increasingly prevalent worldwide over the past decade. The causes of such shortages are multi-factorial, including shortages of raw materials, manufacturing difficulties, increased demand, product recalls due to potential quality defects, and industry consolidations. Medicine shortages can originate at any point in the supply chain. They can involve and impact many stakeholders in different ways, as the supply models and clinical use of therapies can vary across national health systems.
Medicine shortages and their prevention are not unique to Ireland. Similar increases in demand and medicines shortages have been observed in the UK, throughout the EU and across the world at present. In the case of medicines used most often in Ireland, there are typically multiple alternatives available from various sources that remain available to ensure continuity of treatment. Of the products currently in short supply, alternative treatments are available for every single product.
Management of medicines shortages necessitates a multi-faceted, multi-stakeholder response to ensure patient safety, continuity of care and protection of public health. To that end, at the request of the Department of Health, the Health Products Regulatory Authority (HPRA) has assumed a coordinating function in Ireland’s response to managing medicine shortages when they occur. The HPRA is generally informed of a medicine shortage by the relevant pharmaceutical company. Shortages can also be notified to the HPRA by other stakeholders across the health system. In each case, the HPRA will work with relevant stakeholders as necessary, including the HSE, to coordinate an effective approach to the management of a confirmed product shortage. The HPRA engages with stakeholders to coordinate actions and share information to prevent or mitigate the impact of medicine shortages when they occur.
The HPRA publishes a list of medicines currently in short supply on its website (Medicines Shortages (hpra.ie) with the reason for the shortage and expected dates for the return of supply. The information is available to assist healthcare professionals in managing medicine shortages when they arise and reduce their impact on patients. The information relating to shortages on the HPRA website is dynamic and changes depending on the current information the HPRA has to hand, including removal from the list when a shortage has been resolved.
The Department of Health and the HPRA are working closely together to identify any further steps that can be taken to optimise the national response to shortages.
1321. Deputy Colm Burke asked the Minister for Health if he will give full consideration to the appointment of a chief pharmaceutical officer within his Department to develop and coordinate a national strategy for pharmaceutical care; and if he will make a statement on the matter. [12933/23]
View answerThe Department of Health recognises the key role of Pharmacy in the Community, and the ongoing significant contribution made by this sector to patients and the public, particularly during the pandemic.
The potential role that pharmacy may play in the development and implementation of future healthcare reform, especially in regard to the aims and vision of Sláintecare, is under consideration.
The Department is open to exploring any evidence based appropriately governed services, delivered by appropriately trained professionals which will support this aim.
In this regard a number of proposals and ways to progress the potential extension of the scope of practice of community pharmacists in the short, medium and longer term are currently being considered.
To answer the specific question, at this time currently there are no active proposals to develop a Chief Pharmaceutical Officer role in the Department of Health.
The Department has professionally qualified pharmacists among its staff. Furthermore a number of units within the Department have responsibility for advancing policy in key areas of our health system. They are cognisant of potential deliverables that can be realised by and through pharmacists and pharmacy services, to deliver patient centred care in line with the vision of Sláintecare.
1322. Deputy Colm Burke asked the Minister for Health if he will fully consider the allocation of sufficient funds to support future service delivery in the community pharmacy sector; and if he will make a statement on the matter. [12934/23]
View answer1324. Deputy Colm Burke asked the Minister for Health if he will give due consideration to the additional workload placed on community pharmacists in managing medicine shortages when reviewing their dispensing fee (details supplied); and if he will make a statement on the matter. [12936/23]
View answer1325. Deputy Colm Burke asked the Minister for Health the steps he will take to ensure that community pharmacists, as essential members of the primary care team, are totally integrated and embedded into community health networks; and if he will make a statement on the matter. [12938/23]
View answerI propose to take Questions Nos. 1322, 1324 and 1325 together.
As Minister for Health, I recognise the significant role community pharmacists play in the delivery of patient care and acknowledge the potential for this role to be developed further in the context of health service reform. Their participation in the national COVID-19 vaccination rollout – the largest ever undertaken by the State – and in the recently launched free contraception scheme are examples of the importance of their role in the functioning of our health service.
The current fees payable to contracted community pharmacists under the community drug schemes are set out in Statutory Instrument no. 639 of 2019. These regulations were made under Section 42 of the Public Service Pay and Pensions Act 2017.
Subsection (14) therein requires that a review of the operation, effectiveness and impact of the fees set in that regulation be undertaken in 2023. This review must consider the appropriateness of the fees set, having regard to any change of circumstances and any alteration of the matters set out in subsection (10) therein, including the following:
- the nature of the services rendered by different classes of service providers and the general nature of expenses and commitments of the service providers providing those services.
- the obligation on the part of the State to have a prudent fiscal policy under the Stability and Growth Pact and the Fiscal Compact.
In conducting the review, the Department will be cognisant of proposals regarding extending the scope of practice offered by community pharmacists, ensuring that future healthcare expenditure under the community drug schemes is sustainable, and the role that community pharmacy should play in the reform of health service delivery as envisaged in Sláintecare. On this latter point, it is imperative that community pharmacists are recognised as an integral part of the delivery of both safe and efficient patient health care in the community.
Of course, any publicly funded pharmacy service expansion should address unmet public healthcare needs, improve access to existing public health services, and provide better value for money.
1323. Deputy Colm Burke asked the Minister for Health the steps he will take to expedite the registration process for pharmacists from outside the European Union; and if he will make a statement on the matter. [12935/23]
View answerThank you for your question - the number of registered pharmacists on the Register of Pharmacists held and maintained by the Pharmaceutical Society of Ireland (PSI), the pharmacy regulator has continued to grow steadily over the past five years with 7083 pharmacists registered with the PSI on the 1 March 2023, under established processes based in Irish and EU law.
The Pharmacy Act 2007, as amended provides for three distinct routes to recognition with subsequent registration, of a pharmacist qualification; National, EU and Third Country.
The current Third Country Qualification Recognition (TCQR) process comprises several stages and has been in place since 2009. The PSI is currently undertaking a project to overhaul this route however and to reform it as much as possible, with the PSI Council agreeing a revised policy approach and plan for implementing changes.
A public consultation on revised statutory rules to amend the existing PSI (Registration) Rules has been open since the 24 February, to give effect to the revised TCQR approach. The intent is to streamline the process, both to benefit applicants, PSI administrative process, and the wider public and it is hoped that the new process may be in place in late 2023.
Notwithstanding any changes that may be implemented, the Department appreciates that the PSI must be able to verify that minimum standards are met by each qualification submitted for assessment, which facilitates an applicant to progress to registration. Pharmacists practise in a sector delivering irreversible patient care and treatment, and patient safety and wellbeing must always be assured through a robust and appropriate recognition process being in place.
1326. Deputy Colm Burke asked the Minister for Health the steps he will take to enable community pharmacists to be facilitated in managing therapeutic substitution more effectively, that is, without in all cases the necessity of reverting to a GP for a prescription; and if he will make a statement on the matter. [12939/23]
View answerIn the case of medicines used most often in Ireland, there are typically multiple forms, strengths, brands, and generic medicines available from various sources. Where some individual medicines are in short supply, alternative options such as alternative strengths, brands, and generic medicines remain available to ensure continuity of treatment.
In other jurisdictions shortages protocols are used to facilitate community pharmacists to supply either an alternative quantity, strength, pharmaceutical form, or medicine. Legislation in Ireland already allows for generic substitution (alterative strengths, quantity and forms) but does not allow for therapeutic substitution.
Shortages protocols are product specific and are only used in very limited situations, for example in the UK every draft SSP is reviewed by NHS England’s National Medical Director and Chief Pharmaceutical Officer, who can suggest amendments and raise any potential safety concerns, and Ministerial authorisation is necessary to give effect to the protocol. Each SSP is time limited.
The Department of Health is scoping the introduction of a similar framework, a limited stock supply framework (LSS) in Ireland which will only be used in certain emergency situations such as shortages. This is the case in all other countries that have a protocol in place.
This framework proposal will need very careful consideration to ensure it is underpinned and supported by minimum criteria, which will support the safe and effective working of the process. Legislative amendments will also be required.
There are risks associated for both the pharmacist and patient with substituting prescriptions and the Department will need to be satisfied that these risks are addressed which will impact the timeframe for implementation.
1327. Deputy Colm Burke asked the Minister for Health if he will consider the implementation of a fully functioning and funded national prescribing service, as a priority; and if he will make a statement on the matter. [12947/23]
View answerThe purpose of a national prescribing service is to provide guidance to prescribers in making optimum use of available medicines.
In Ireland, the Health Service Executive’s (HSE) Medicines Management Programme (MMP) performs this role. Their remit is the enhancement of safe, effective, and cost-effective use of medicines in Irish healthcare.
The MMP have identified preferred drugs for prescription in commonly used therapeutic classes including statins, angiotensin-converting enzyme (ACE) inhibitors, and oral anticoagulants. The chosen drugs are recommended to prescribers as a first choice when commencing treatment for suitable conditions. These recommendations follow extensive evaluation which considers clinical efficacy and effectiveness, dosing and administration, drug interactions, side effects, cost, national prescribing trends, and national and international clinical guidelines.
Prescribing guidelines are also developed by the MMP. These are intended to assist prescribers in identifying the optimum medicine for treatment of arising conditions. Guidelines have also been developed in response to shortages to ensure continued treatment and patient safety.
Managed Access Protocols (MAPs) are developed by the MMP. These are used by the HSE to identify those who would benefit most when making a decision to support reimbursement on a patient specific basis. As innovative medicines with high costs are introduced to the market, this enables patients in Ireland who need them to gain access.
1328. Deputy Michael Healy-Rae asked the Minister for Health if a matter in relation to the labelling of alcohol will be examined (details supplied); and if he will make a statement on the matter. [12948/23]
View answerSection 12 of the Public Health (Alcohol) Act 2018 requires that certain health warnings and information be displayed on the labels of alcohol products, on notices in licensed premises and on websites which sell alcohol products. The labels of alcohol products must also contain information on the grams of alcohol and the calories in the product.
Section 12 requires that the notices to be displayed in licensed premises and the notices required on websites which sell alcohol products must be bilingual. In the case of labels on alcohol products, the information is required in the English language only. Section 12 was enacted in this manner in 2018 in the interests of proportionality i.e., to lessen the burden on businesses who would be required to put these six additional pieces of information on the labels of their products for the first time.
As section 12 requires bilingual notices in both on-licensed premises and off-licensed premises, as well as on websites that sell alcohol products, this requirement was enacted in 2018 in a way to ensure that the relevant information will be available in the Irish language to all consumers.
1329. Deputy Peter Burke asked the Minister for Health the options that are open to front-line staff contracted by the HSE during the Covid-19 pandemic who have not received their recognition payment (details supplied); how staff in similar roles, but in different HSE areas, have received the payment; the reason some companies contracted by the HSE are not applying for the payment; and if he will make a statement on the matter. [12963/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly.
1330. Deputy Michael Ring asked the Minister for Health if he will ascertain from the HSE when funding will be released from an agency to an organisation (details supplied); and if he will make a statement on the matter. [12975/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly.
1331. Deputy Róisín Shortall asked the Minister for Health if he will allow community pharmacists to dispense oral contraceptives without the need for a prescription, in line with WHO best practice; if not, the reason for continuing this barrier to accessing oral contraception; and if he will make a statement on the matter. [12986/23]
View answerThe free contraception scheme for women was launched in September 2022, and is currently open to women aged 17-26 who are ordinarily resident in Ireland. The scheme will be expanded further, in September, to include women aged 30 and under. Funding through Budget 2023 was also allocated to expand the scheme to 16 year-olds, but this is subject to consultation across Government, legal advice and legislative amendment.
Over 2,200 GPs and 1,850 pharmacies have signed up to provide products and services under the scheme to date. The role of pharmacists currently involves dispensing prescription contraception prescribed for individuals by a medical practitioner, typically their GP or family planning clinic.
Some forms of contraception, most commonly the progesterone only Pill, but also in certain circumstances, a combined hormonal contraceptive (the “combined” Pill) are available through pharmacies, without the need for a prescription, in other jurisdictions. Providing some services in this manner in Ireland may improve access to contraception for women. Work on developing potential options for an enhanced role for pharmacists in relation to the provision of contraception is ongoing.
In Ireland at present, accessing oral contraceptives is regulated and requires a prescription from a medical practitioner in accordance with the requirements of the Medicinal Products (Prescription and Control of Supply) Regulations 2003, as amended. These regulations apply a comprehensive system of control to medicinal products and identify those products which may only be supplied on medical prescription, and also specify the circumstances excluding medicinal products from prescription-only control. Schedule 8 to the regulations lists those medicinal products which may be supplied and administered by pharmacists pursuant to regulation 4B, where that pharmacist has completed approved training regarding the administration of such products and the management of any adverse reaction. In order to enable pharmacists to supply the specified products alluded to in your question without the need for a prescription, detailed clinical consideration is required in the first instance to ensure that various patient safety issues are fully respected.
Following previous engagement with representative groups, my officials at my direction, are currently engaged in a process, which includes obtaining recommendations from relevant clinical experts within the HSE as to the clinical appropriateness of making some forms of currently prescription controlled contraception, available through pharmacies without the need for a prescription. This process is ongoing.
Thereafter, and with due consideration of the policy position adopted and underpinned by appropriate clinical recommendations and advice, the modality of giving effect to this decision will be considered. Any mechanism introducing this change, or indeed giving effect in a given instance to any other policy decision, must be robust, appropriate in the given context, and legally sound.
1332. Deputy Róisín Shortall asked the Minister for Health the reason community pharmacists are not reimbursed for administering the shingles vaccine; and if he will make a statement on the matter. [12987/23]
View answerThe Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drug schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
The HSE does not supply vaccines or provide reimbursement support for vaccines through community pharmacies under the Statutory Drug Schemes. When the public health imperative to support particular vaccines to defined cohorts becomes national policy, vaccines are directly procured by the HSE and supplied through the national vaccine distribution arrangements to GPs for eligible cohorts.
The immunisation programme in Ireland is based on the advice of the National Immunisation Advisory Committee (NIAC). The committee's recommendations are based on the prevalence of the relevant disease in Ireland and international best practice in relation to immunisation.
The NIAC continues to revise recommendations to allow for the introduction of new vaccines in Ireland and to keep abreast of changes in the patterns of disease. Therefore, the immunisation schedule will continue to be amended over time. Shingles vaccination is not currently provided as part of the national immunisation programme.
However, it is open to an individual to source a vaccine from a GP or pharmacy, where available, outside of the national immunisation programme on the basis of a private arrangement.
1333. Deputy Róisín Shortall asked the Minister for Health the timeline he is working towards to develop a new rare disease strategy; if this strategy will address the significant delays in the drug reimbursement approval process, which can lead to a huge financial cost for people with rare conditions; and if he will make a statement on the matter. [12994/23]
View answerI recently announced my intention to bring forward a successor plan to the existing National Rare Disease Plan 2014 - 2018. While this work was delayed by the pandemic, the Government has continued to invest significant resources in the area of new medicines in recent years. In 2021 nineteen (19) orphan medicines for rare diseases were added to the reimbursement list. In 2022, the number was sixteen (16), and to date in 2023, already there are twenty-seven (27) new orphan drugs undergoing pricing and reimbursement assessment.
Last month, I published the Mazars Review which examined the governance arrangements around the HSE’s Drug Pricing and Reimbursement Process. I fully support the recommendations contained in the Mazars report that improve the process, provide easier access, and support value for money. An implementation group is being established between my Department and the HSE to consider and progress the various recommendations contained in the Report as well as other options to improve the process. The Group will engage with stakeholders including patient groups and industry, in seeking to bring about further improvements to the reimbursement process.
1334. Deputy Róisín Shortall asked the Minister for Health if he has reviewed the Health Service Executive’s Capital Plan 2023, as approved by the HSE board; and if he will make a statement on the matter. [13004/23]
View answerI can confirm that The Health Service Executive’s Capital Plan 2023, as a related document of the National Service Plan, has been submitted to me for my review and approval.
Capital core funding allocated in 2023 for the construction and equipping of healthcare facilities is €967m, an increase of 11% over 2022 core allocation plus an amount of €50m for Covid infrastructure projects. This investment will enable the HSE to progress projects across the country in 2023. Projects and Programmes being progressed include:
- New Children’s Hospital
- Capacity projects including critical care beds and acute hospital beds
- Elective hospitals
- Relocation of the National Maternity Hospital and other maternity services projects
- Primary Care Programme including the building and equipping of centres across the country
- HIQA Programme for Community Nursing units involving refurbishment to HIQA standard of units throughout the country
- Mental health facilities including CAMHS units and acute mental health units across the country
- Accommodation for Enhanced Community Care programme
- Investment in Trauma and Rehabilitation projects
- Equipment replacement and infrastructural risk projects
- Investment in Climate Action and Sustainability projects
- Replacement ambulance programme and ambulance bases renovation
I am working with my officials and the HSE in the review of the plan and expect the approved plan to be published in the coming weeks.
1335. Deputy Niall Collins asked the Minister for Health the budget for residential care in 2020, 2021, 2022 and 2023; and if he will make a statement on the matter. [13005/23]
View answerThe Nursing Home Support Scheme (NHSS), commonly referred to as 'Fair Deal', is a system of financial support for people who require long-term residential care. The primary legislation underpinning the NHSS is the Nursing Home Support Scheme Act 2009. Participants in the NHSS contribute to the cost of their care according to their means while the State pays the balance of the cost. The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone, and that people are cared for in the most appropriate settings.The budget for the provision of long-term residential care services under the Nursing Homes Support Scheme for the years 2020 – 2023 was as follows:2020 - €1.036bn 2021 - €1.052bn 2022 - €1.053bn 2023 - €1.094bnIn addition, since the start of the pandemic, private and voluntary nursing homes have also received a wide range of non-financial supports, including over €74m in free PPE and oxygen, as well as over €148m of financial support through the Temporary Assistance Payment Scheme (TAPS).A €10 million Temporary Inflation Payment Scheme (TIPS) was also introduced to support private and voluntary nursing homes with increases in energy costs in 2022. The scheme covers 75% of year-on-year cost increases in energy and heating, up to a monthly cap of €5,250 per nursing home, to initially cover the period of July to December 2022. Eligible nursing homes can claim three-quarters of €7,000 of vouched expenses overall, up to a maximum of €31,500 per nursing home.Cognisant of the present financial pressures, Ministers and Departmental officials continue to consider other measures to further support the nursing home sector.
1336. Deputy Niall Collins asked the Minister for Health if he will provide an update on a matter (details supplied); and if he will make a statement on the matter. [13006/23]
View answerSenior Officials in my Department continue in their efforts to ensure this matter can be brought to a satisfactory resolution as quickly as possible in compliance with the recommendations outlined in LCR19986, whilst taking account of the part settlement acknowledged by FORSA in their letter to the HSE on 13th April last.
13th April 2022
Re: Forsa Sectoral Bargaining Units
Dear Paul,
I refer to your e-mail of the 5th of April 2022 in the above regard wherein you set out the terms of section 2.1.5 of Building Momentum and sought the formal position on Sectoral Bargaining Claims.
The Forsa position on Sectoral Bargaining Claims was set out clearly at our meeting on the 22nd of March and is as follows:
- The Senior grades comprehended by the Report no. 42 of the review body on Higher Remuneration will accept 1% during the lifetime of this agreement as part settlement of this outstanding matter which still requires absolute resolution following expiry of the current agreement.
- The maximum point on the General Manager scale should be adjusted to a level equivalent to the overall cost, which would occur if a general round increase of 1% on all scale points was to be applied. This adjustment is in part settlement only of the outstanding benchmarking II award (5%) in respect of the grade of general manager and the remainder of this claim must still be resolved following the expiry of the current agreement.
- The maximum point on the Principal Social Worker scale should be adjusted to a level equivalent to the overall cost which would occur if a general round increase of 1% was to be applied. This adjustment is in part settlement only of the outstanding benchmarking II award (8.5%) in respect of the Principal Social Worker grade and the remainder of this claim must still be resolved following the expiry of the current agreement.
- The employer’s side has refused to discuss sectoral bargaining in respect of Health and Social care professionals until the matter relating to Hospital Pharmacists has been processed through the Labour Court.
- Clerical and Administrative Grades III to VII will accept a Sectoral Bargaining 1% increase. Arrangements for payment of same should be made immediately as was the case in other sectors.
- Discussions on outstanding matters in respect of Chief Officer, CHO’s and Emergency Management Officers remain underway. Discussions on Finance Restructuring are also scheduled to commence shortly.
- Management grades not referenced above should be subject to a 1% Sectoral Bargaining adjustment.
As ever I remain available to discuss the matter with you.
Yours Sincerely
Éamonn Donnelly
Head of Division, Health and Welfare
[< ahref="https://data.oireachtas.ie/ie/oireachtas/debates/questions/supportingDocumentation/2023-03-21_pq-1336_en.pdf">Fórsa Sectoral Bargaining Position</a>]
