Saincheisteanna Tráthúla - Topical Issue Debate

State Examinations Appeals

I thank the Ceann Comhairle for selecting this issue and it is good that the Minister for Education and Skills is present to respond on what I am sure he will agree is a most serious issue.

Last week the High Court ruled in favour of Rebecca Carter, a young woman who was forced to take the State to court to start in her chosen college course. While we had lots of sympathy from the Government last week, for example, when the Minister for Employment Affairs and Social Protection, Deputy Regina Doherty, took Leaders' Questions, the truth is that this lady had to put herself and her family at considerable risk to achieve the just outcome she deserved. Thankfully, she has since started college, but the case has left a number of serious issues to be resolved.

It is important to put on the record some of the issues that came to light during this court case. Approximately 54,500 students sat the leaving certificate examinations this year. I am told the State Examinations Commission issued 383,764 grades from approximately 600,000 individual scripts. The proportion of appeals lodged against grades issued this year is very low, at 9,092 scripts from 5,200 students, or approximately 10%. When appeals over oral exams are included, I believe the number of items to be corrected on appeal was about 15,000.

Even though 10% of students and less than 2% of scripts go to appeal, it takes 40 days to recheck the appeals as opposed to 54 days to mark the entire leaving certificate. This is a system that is not fit for purpose. A total of 1,652 examiners corrected the scripts at first instance. This drops to about 400 for the appeals process. These figures came out during the court hearing and I am grateful to my correspondent who gave me them. The State Examinations Commission has offered no explanation for the 75% reduction in the number of examiners available for appeal. Why does that happen? The judge in the case noted that if the same number of examiners, who had been available for the initial corrections, were available for the appeal, then all the appeal scripts could have been completed in one day.

Given the facts revealed to us in a court action by a citizen at cost to her family, it is not surprising that Mr. Justice Humphreys stated that the system was "manifestly not fit for purpose". It is a ridiculous state of affairs. I have no wish to make a political football of this because the State Examinations Commission must be seen to be a non-political, impartial, fair judge of the achievements of students in leaving certificate examinations. However, the Minister and the State Examinations Commission need to get on top of this for next year.

We need to establish the scale of the issue and some of the facts have been set out very starkly in the court action before Mr. Justice Humphreys. Many other students are waiting to have their appeals finalised by the second week of October and some of them will also have missed college entry. We estimate - the Minister might confirm this - that approximately 300 students every year could have their points increased sufficiently to get a particular college place that they otherwise would not have been offered. This weekend, The Irish Times indicated that several hundred students annually end up securing higher-preference college places. Is it in the region of 300 students?

Is this an issue that is linked to business studies or is it a general issue? As I mentioned in a radio interview, I am certainly aware of another case where marks for a business studies paper were incorrectly moved from the front of the exam paper to the exam sheet. Is the Minister aware of other cases? Is there a timeline for a review? Is the State Examinations Commission appealing this decision? Is it not accepting the judge's findings? Crucially, is it paying the costs of Rebecca Carter and her family in this action?

I thank the Deputy for raising the issue. I also thank him for withdrawing it last week when I was unable to take it because I wanted to give it seriousness.

I am pleased that Rebecca Carter got the course she wanted, which is great. However, the Deputy is right that we do not want young people having to go to court to get access to college courses. Since the ruling was made, as the Deputy knows, the State Examinations Commission has met. It arranged for the correction of Ms Carter's paper. It also has indicated to its executive that it wants an urgent review of the timelines involved. It is clearly taking responsibility in this. I have convened for this week a meeting of State Examinations Commission and the higher education institutions to find out how we can resolve the issue.

As a backdrop to this - I will deal with some of the points the Deputy made - one of the key changes made this year, as the Deputy probably knows, is that UCD issued a decision that students who, after 30 September, got upgrades in their results could not participate in this year's course.

That was a significant change. However, as the Deputy rightly said, the case has also revealed long time lags in the appeals process and, while the State Examinations Commission is independent, we will need to look at them. Some of them start from the process the commission undertakes after 15 August when it issues all scripts back to schools for examination and gives until 5 September for a decision to be made as to whether a case will be appealed. It then takes from 5 September to 10 October to retrieve the scripts, dispatch them to the examiners and have the examination carried out. The commission also applies more due diligence or quality assurance to the rechecking than the initial process, with a higher level of re-sampling of scripts corrected. Clearly, while it is right that the commission has a robust system in place, we have to shorten the timescale.

Another factor at play is that, increasingly, colleges are starting their terms much earlier than they used to. There was a time when they did not start so early and the schedule was in line. Therefore, UCD makes a reasonable point that a student starting six weeks into a course is going to miss something. We need to resolve this issue. I have to recognise the independence of both the colleges in determining their admission policies and the State Examinations Commission, given that this independence is something the public rightly values. Notwithstanding that, we can do a lot better in shortening the timescale.

On the turnover of results, the Deputy is correct. The level of 9,800 this year is not low and is typical, with 9,500 being the figure for last year and approximately 9,000 for other years. Some 14.5%, or approximately 1,400, are upgraded. The figure for those who receive offers is significant, with over 400 receiving offers as a result of an upgrade. The vast majority take up the offers in the same year, but some opt for deferral to the following year, although this option was not available in UCD as there had been a change. We can do much better in that regard. I will be working with the two bodies concerned to make sure we resolve this issue.

I thank the Minister for clarifying that there are 400 students whose course and, possibly, life changes as a result of the appeals process. I can well understand why some of the higher education institutions want to get this done as early as possible - I imagine veterinary science, in particular, is one relevant subject - given that there are limits on the numbers of students who can take practical lessons and so on.

The Minister's key role is to try to join the education system together. Clearly, in this case, he has allowed it to slide. UCD was allowed to make the change without any reference to the Minister or the State Examinations Commission, yet the Minister is only calling a meeting to discuss it after the horse has bolted, somebody has put their financial security at risk by taking a High Court action and others have lost out. However, it happened this year and we cannot blame UCD for it. The blame really lies with the Minister for not bringing everyone together to try to work out a common-sense solution. It takes too long to deal with appeals. It seems to be an administrative process that has been allowed to slide. The approach appears to be, "It happens every year and this is the way we do it. We are independent and no one can interfere with us." That has to end.

What the Minister has not said is whether he accepts the decision of the High Court and whether he and the State Examinations Commission will appeal the decision of Mr. Justice Humphreys who will, I understand, be issuing a written judgment in the next few weeks and ordered that the system be changed before next summer. The Minister needs to give an indication that, apart from having a meeting this week with the universities and the State Examinations Commission, which is way too late, given that it should have been done when it became apparent that UCD was changing its policy, the system will change for next year's examinations in accordance with the order of the High Court. Is this something the Minister has agreed to do, or will the State Examinations Commission faff around for the next few weeks and then appeal the decision to the Court of Appeal? The Minister needs to let us know because students and the universities need to know. We need certainty and an examination system in which people can have confidence. Unless the Minister accepts the judgment of Mr. Justice Humphreys, confidence in the State examinations system will be shattered.

First, I do not accept the Deputy's contention that I should have directed the State Examinations Commission. It is an independent body and was established as such. In the case of any examination script where a student can apply for rectification, the commission has criteria whereby it re-tots and immediately gives the result. In other cases it does not provide for rectification because the issues are more complex and it needs to look at a paper to evaluate it. It is absolutely right that it is the commission that should make the decision, not me or-----

I did not suggest the Minister should make it.

The Deputy should look at the "blacks". He suggested it should not be independent and-----

I suggested the Minister should have brought the State Examinations Commission and the universities together before the rule was changed.

The Deputy has made his point.

The Deputy did say it. If he looks at the Official Report, he will see what he said. The board has accepted the court judgment. It has rechecked and made a decision that its executive should review the unacceptable timelines. I have not seen the written judgment, nor have they. Obviously, they will have to see the written judgment, but from my point of view, we are determined to ensure this will not happen again. We have to ensure the timelines will be shortened, while in no way undermining confidence in the leaving certificate examinations process. That is in everyone's interests. The colleges rely exclusively on the State Examinations Commission in their admission policies. They do not have independent admission policies, although they are independent in changing the rules. There is something of an anomaly in that they can change the rules without notifying the commission, but that is their right. I am determined to ensure we will resolve the issue without impinging on the independence of either of the bodies.

Broadband Service Provision

It is welcome that I finally have the opportunity to raise this issue. There is the roll-out of broadband to many homes, although other homes just metres away will not be able to avail of the roll-out. This and the previous Government's record in the roll-out of broadband has been dire. The facts do not lie. Ireland lies 42nd in the global ranking for the distribution of high speed broadband, while 40% of the population and 96% of the country lack access to commercial or fibre broadband coverage. That represents a figure of approximately 2.3 million premises.

On behalf of the Government, the Minister signed an agreement with Eir to provide broadband for 300,000 premises. I want to know how these premises were identified. Clearly, it was done by way of a desktop exercise, with no relevance given to how it would impact on the ground. I can give scores of examples where there is the roll-out of broadband to one house on a road but not to the next, or it is occurring at either end of the road, leaving five houses in the middle without a connection to broadband. They include places such as Lynn Road, Mullingar; Tornanstown; Gaybrook; Knockaville; Killucan; Cumminstown; Ballinacarrig; Irishtown, Mullingar; Kilbeggan; Coola Lawns, where certain houses in the estate have access to broadband, while others do not; Ballinamudda; Moate; and Killinure North, Athlone. These are just a number of examples.

In reply to a parliamentary question the Minister said any decision by the company to provide a service for premises not covered by the commitment agreement would be a matter for it, not one in which he had any role. That is factually incorrect. No matter when I contact the company about the provision of broadband in all of these areas, it states it is prohibited from rolling out the service any further. It is disgraceful.

That is the kernel of the issue. It is about whether the contract needs to be altered by the Government to allow Eir to proceed. There are scores of areas throughout the country, including my own, where the Eir roll-out is coming. We can talk about the major issue in relation to broadband, but this is specifically about the contract that has been given by the Government to Eir. We have communities in places where the company is stopping, yet there are only three or four more houses to go on the line. Instead, a different line comes from a different direction. We have places like Banteer, Knocknagree, Bweeng, Cullen, Newmarket, Lisrobin, Boherbue and Ballinora where this is coming to a specific location. We have contacted the Department which says it is Eir's responsibility to extend the line. When we contact Eir, it says it is prohibited from going any further because of the contract it has been given by the State. Someone needs to tell us who is blocking this and how it can be changed. It makes no sense from a logistical or common-sense point of view to have roads being divided completely by this. The Minister must look at it and ensure there is flexibility within the contract to allow the company to complete a particular section of road which may involve only three or four houses. In some instances, there are different telephone exchanges coming from either side, with one or two houses left in the middle. Eir tells us the Government and the contract prohibit it from extending it and the Government tells us it is Eir. Both cannot be right. Someone somewhere is telling untrue stories. We need to get to the bottom of it and we need flexibility to allow common sense to prevail. There is a whole different argument about the fact that the different commitments on broadband do not add up.

I thank Deputies Troy and Michael Moynihan for raising this issue. I welcome the opportunity to address the House on the matter. As appears from the reply to Question No. 78 of 18 September 2018, the Minister for Communications, Climate Action and Environment, Deputy Naughten, signed a commitment agreement with Eir in April 2017 on the plan to provide high-speed broadband to 300,000 premises in rural areas on a commercial basis. Eir states that to date more than 177,000 premises have been provided for. The national broadband plan aims to deliver high-speed broadband to every citizen and business in Ireland. This has been achieved through a combination of commercial investment and State-led intervention. Under EU competition rules, the State can only intervene where there is evidence of market failure and where commercial investment is unlikely. Eir selected some 300,000 premises for high-speed broadband based on the company's own analysis. These premises had been categorised for inclusion in the State intervention area under the national broadband plan. In April 2017, my Department determined that the company's deployment plans were credible and, accordingly, the premises were deemed commercial and removed from the State intervention area.

The Deputies queried the assessment of properties on a case-by-case basis. Eir has selected the premises to be included in its roll-out on the basis of internal commercial criteria as permitted when commerciality of an area can be demonstrated. Neither the Minister, Deputy Naughten, nor I nor my Department had any input in that process. My role and that of the Minister relate only to oversight and verification that these premises are passed according to the milestones laid out in the commitment agreement. Eir has stated publicly that it is not in a position to include additional premises on a case-by-case basis and this is entirely a matter for the company. All commercial decisions are matters for private operators in the market. I appreciate the frustration felt by people who see the deployment by operators throughout the country but who themselves continue to wait for a high-speed broadband service. Those premises not served through a commercial investment will be included in the State intervention area, which will build a high-speed broadband network in the areas not served by the commercial operators.

The Department is engaged in the formal procurement process to select a company to roll out a high-speed broadband network in the State intervention area and is now evaluating the final tender submission received from the bidding consortium on 18 September 2018. This is a significant milestone as the national broadband plan procurement process enters its final stages. I assure the House that every day more and more people in every county benefit from access to high-speed broadband as a direct result of the Government's action on the national broadband plan. I continue to be committed to the delivery of high-speed broadband to every home and business in Ireland. Today, of the 2.3 million premises in Ireland, seven out of every ten have access to high-speed broadband and it is anticipated that by the end of the year, that will grow to eight out of ten. The milestones are important. It is expected that a tender will be signed with the final bidder before the end of the year with roll-out to start in the intervention area for all 540,000 premises from 2019 on. That will take time. It is expected that from early 2019, every house will be told exactly when it will be connected.

I share the Deputies' frustration regarding the process under which Eir selected the houses. I have made representations as a constituency Deputy to the company on houses which have been left out when the line has not been extended further up a road. I share the frustrations all Members have and, like them, I can identify areas of need. We also accept, however, that the push with the national broadband plan and the pressure applied to the commercial operators mean Eir has agreed a commitment contract with the Department which will deliver 300,000 connections. We must appreciate that. While people have been left out, 300,000 will be connected to high-speed broadband because of the commitment contract signed with the State. Unfortunately and no more than with the intervention area decided on, not every house can be connected in the one year, month or week. Things have to start somewhere and we want to ensure a regional spread when the intervention area is rolled out.

The Minister refers to the 177,000 premises which have been connected, but we are raising the matter of the thousands of houses which are not going to be connected. The Minister of State has not given them any hope. He is telling them the tender process for the national broadband plan will not be completed until the end of this year. We know, based on the past record of the Government, that the timetable might not even be adhered to. It will take a number of years until such time as it is rolled out. People in the areas I have outlined could be waiting for between three and five years to have access to broadband. Meanwhile, there is a broadband provider in their vicinity and on their roads providing broadband to their neighbours which they cannot avail of. We need a little bit of creativity and some thinking outside the box. As Deputy Michael Moynihan said, it makes logistical, creative and economic sense if we are going to pay a contractor in an area to have it finish out the area rather than leave people without broadband. If we are serious about encouraging people to live in rural Ireland and about having businesses operate there, we must be serious about rolling out broadband for rural areas. Unfortunately, the Government has not been serious about that.

Before the Dáil is a discussion on the Eir contract with the Department. There are small numbers of people at the very end of each line to whom broadband should be extended. If there are eight to ten houses, the line should be completed. It is common sense for the Department to call Eir to ask whether there are communities where a small amount of further investment on the contract would complete the roll-out of broadband locally. The Minister of State provided all of the statistics on the roll-out of broadband. I have listened to that for four or five years and I consider it to be pie in the sky. I cannot see any future to it. I ask the Minister of State about the five to ten houses at the end of communities and whether the Department will ask Eir to apply some flexibility. Eir tells us it cannot do it because of Department rules while the Department says it is Eir. Will the company be brought in to discuss it for the sake of a very small number? It is common sense and financial sense. Above all, it would solve the problem on the ground.

Eir is a private company, as the Deputies should know, given its privatisation in Fianna Fáil's time when the infrastructure was sold off. The Government signed a commitment contract with Eir to connect 300,000 houses which the company identified. The houses the Deputies talked about that are at the ends of roads will be part of the intervention area under the national broadband plan. The final tender has been received and is being evaluated by the Department and it is expected that a contract will be signed before the end of the year with an expectation that, from 2019 onwards, these houses will be connected. I cannot provide the Deputies with a timeline for each house, but it is expected that from 2019 on, every house will know when exactly it will be connected.

As to who will decide where in the intervention area the houses to which the Deputies refer will be connected or where they will start, it would make perfect sense to me, and possibly to the Deputies, that where Eir goes halfway up a road connecting houses, this would continue as part of the intervention area under the contract. This is not for me to decide; the tender must be evaluated. I understand Eir will look at the best technical and engineering solution to the roll-out. The most important thing is that we have a geographic spread, all areas are covered and there is a timeline such that there is certainty for those households not currently connected. From my understanding, my Department is neither involved in nor aware of any process for the inclusion of premises in Eir's deployment on a case-by-case basis. Eir is entitled to deploy outside the areas planned under the 300,000 deployment, as any operator would be, but it publicly and very strongly indicated it is not in a position to do so on request. It states that it can make decisions on a commercial basis, but the Government has signed off on, and Eir has given a commitment to, the 300,000, so Eir must ensure that those 300,000 houses are complete. What Eir does after that on a commercial basis is up to the company, but those houses that are not covered on a commercial basis will be covered under the national broadband plan intervention area.

Hospital Overcrowding

I thank the Ceann Comhairle for selecting this important issue for debate. Overcrowding at the accident and emergency department at University Hospital Limerick, UHL, continues to be a major problem. In the past two months alone, a staggering 900 patients at the hospital have been placed on trolleys, the highest number recorded in the country. There are many contributory factors to this, including that some surgical theatres and consultants are not available seven days a week, but the major issue is a lack of acute bed capacity in the region. In fairness to management at UHL, it has put forward two projects to boost significantly bed capacity, namely, a 60-bed modular unit and a new 96-bed block proposal.

The 60-bed modular unit was recently granted full planning permission by Limerick City and County Council. It is extremely regrettable, however, that this vital project has been stalled because of a planning objection on the part of a resident of Dooradoyle in Limerick. This project is of critical importance to healthcare provision in the mid-west region, servicing counties Clare, Limerick and north Tipperary, as it will improve patient flow throughout the hospital, patient comfort, patient safety, privacy and patient dignity. It is outrageous that one individual can hold up a project of such importance. I have taken this matter up with the Minister of State with responsibility for planning, Deputy Damien English. It is my view that strategic projects such as this should be lodged directly with An Bord Pleanála. While I have no wish to deprive people of the right to appeal against planning decisions, it makes sense to give An Bord Pleanála the right to deal directly with applications for major public service projects as such an approach would streamline the process and allow people have their views considered without compromising the public interest.

What is the Minister of State's position on this project? With winter almost upon us, what contingency plans are in place to deal with the severe overcrowding at UHL? More can and must be done with the smaller hospitals in the region, including at Ennis and Nenagh and St. John's. Does the Minister of State agree with this? What plans does he have to involve these hospitals more?

I support Deputy Carey's comments on the smaller hospitals or sister hospitals of the University Limerick hospitals group in the mid-west. We have been told to use these facilities, particularly the injury clinics. If I injure myself playing a match, the first place I will think of is UHL in Dooradoyle. We do not know what specific services are provided by the other hospitals, whether St. John's, Ennis or Nenagh. A major communications strategy needs to be put in place to ensure these facilities are used to their capacity to try to take the heat off the emergency department in Dooradoyle. I have asked for such a communication plan before. It is now paramount this is done, given where we are. I welcome that the Government is moving on the 96-bed unit project in conjunction with the hospital group. I understand it is at design stage and I hope it will soon proceed to tendering. I would like an outline of the design timelines for the project.

As for the modular unit, everyone has a right to appeal and to object - I have no problems with that - but with this process we are looking for something so urgently that I echo Deputy Carey's sentiments that the likes of this should go straight to An Bord Pleanála. I mean no disrespect to the council, on which I sat for a number of years, but this is a strategic project that warrants a streamlining and fast-tracking of deadlines. We are talking a number of months. As Deputy Carey said, 880 people were placed on trolleys in UHL in June and use of the hospital's emergency department increased by 17% in the past year, and is ramping up all the time. I would like to hear the Minister of State's comments on this and I will follow up on them afterwards.

On behalf of the Minister for Health, Deputy Harris, I welcome this opportunity to address the House on the issue raised by Deputies Joe Carey and Tom Neville. I commend Deputy Joe Carey on his great work on health in County Clare and Deputy Tom Neville on his support for services throughout Limerick.

The Government is committed to breaking the cycle of overcrowding in our health service. Emergency department overcrowding has been linked to many adverse outcomes, such as longer wait times, worse patient outcomes, treatment delays and growing staff and patient dissatisfaction. The emergency department in University Hospital Limerick is one of the busiest in the country, with approximately 67,000 attendances annually. Demand for ED services at the hospital continues to rise, with an increase of 6% in ED attendances in UHL in 2017 compared with 2016.

The Department of Health undertook a health service capacity review in line with the commitment in A Programme for a Partnership Government, the findings of which provide an evidence base for future capacity decisions. If reforms are implemented, the report concludes that nearly 2,600 additional hospital beds will be required by 2031. The national development plan provides for the full 2,600 beds by 2028, three years ahead of schedule. The national development plan announcement earlier this year includes provision for a 96-bed replacement ward block at University Hospital Limerick. The HSE has provided capital funding in 2018 to progress the design phase of this project. Further funding will be considered in the context of the capital allocation for health, having regard to the availability of funding and the level of contractual commitments already in place. Subject to funding and the successful completion of the planning, design and tender phases, it is currently anticipated that construction is unlikely to commence before 2021.

Given the current pressures on our hospital emergency departments, the Department of Health has engaged with the HSE to identify the location and mix of beds across the hospital system which can be opened and staffed this year and into 2019. A proposal from the HSE, which identifies approximately 600 additional acute beds and 290 additional residential care beds to be phased in between 2018 and 2020, is under consideration in the Department. These proposals include a 60-bed modular unit at University Hospital Limerick.

Therefore, while I understand the Deputies' wish to have a clear response today on the provision of additional beds in UHL to alleviate the ongoing pressures on the ED, I must await the outcome of the processes currently under way. These include matters which are being considered in the context of the 2019 Estimates process. I will convey the Deputies' sensible concerns and suggestions to the Minister.

I thank the Minister of State. Ennis hospital is a vital cog in the wheel here, and I believe more could be done in Ennis to try to reduce the burden on UHL. I welcome the fact that Clare County Council recently granted planning permission to the hospital group to develop a new outpatient department just off the Kilrush Road in Ennis. We need to see further investment in Ennis hospital, particularly in surgical theatres, and an expansion in the opening hours of the medical assessment unit and the minor injuries clinics.

I know the Minister has a view that smaller hospitals can play a bigger role. Does the Minister of State support that position? Will he convey the opinion being expressed here this evening that the smaller, model 2, hospitals in the region need to be better resourced in order that they can play a bigger role?

I reiterate that we need this project to proceed as quickly as possible. From what I hear, dates are being shifted out all the time. The Minister of State is saying today that it will commence in 2021. We need to get this moving faster. I ask that we find a way to fast-track this process. I ask that the person who is appealing the decision to grant planning permission for the project, An Bord Pleanála and the Minister sit down, iron out their differences and come up with a solution so that we can move this forward. People are lying on trolleys under bright lights and having their privacy compromised. I have had phone calls this weekend in respect of some specific cases. Some people have been on trolleys for three or four days. We have been dealing with this for a considerable period.

On diagnostics, I also suggest that we move beyond the nine to five, Monday to Friday model. This has happened in the private sector where people move to weekend shifts and are remunerated and paid bonuses and shift allowances accordingly. We need to start thinking differently in this regard. It is getting too serious.

I pay tribute to the staff in University Hospital Limerick who are working under extreme pressure. A total of 67,800 people attended the hospital's accident and emergency department last year. I understand the new facility will deal with the most acute cases and those who have reached the end of the admissions process for whom staff are trying to get beds. I commend the staff and management because a large number of people have passed through the hospital. It is essential that we get the project through as soon as possible.

Again, I thank the Deputies for raising this very important issue. They made many points which I strongly support. For example, I agree with Deputy Joe Carey on using Ennis general hospital to take some of the burden. He also raised issues regarding the medical assessment unit. As to whether I agree that smaller hospitals can play a bigger role in dealing with this issue, I absolutely agree, and I will convey that view at Cabinet and to the Minister for Health.

Deputy Tom Neville spoke of speeding up the process, fast-tracking the project and An Bord Pleanála. This is something on which we have to act. I agree that it is not acceptable to have patients on trolleys for two or three days. We need to be more proactive and think differently. That is very important when we are planning and designing the health service.

The health service capacity review indicates that Ireland has one of the highest bed occupancy rates in the developed world, at 94%. That is significantly ahead of the OECD average of 77%. This is why the Government has approved a record level of capital investment in health - €10.9 billion over the next ten years. This will provide for major enhancement of the capacity of our health services to meet demand, the issue raised by the Deputies. However, increasing capacity alone will not address the challenges faced by the health system. Investment and reform must go hand in hand. The Sláintecare implementation strategy, which was recently published, provides the framework for how our health service reforms can be realised across primary and social care, as well as acute care. We have now commenced the implementation of the Sláintecare programme.

We all acknowledge that the challenges we face are significant. Of that there is little doubt. However, it is my firm belief that all of us here want to find the right solutions. I have heard some of the Deputies' suggestions but solutions have to be patient-centred, evidence-based, results-focused and sustainable in order to deal with the challenges facing our health services.