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Dáil Éireann díospóireacht -
Tuesday, 26 Sep 2023

Vol. 1042 No. 5

Saincheisteanna Tráthúla - Topical Issue Debate

Water Services

Ar an gcéad dul síos, gabhaim buíochas leis an gCeann Comhairle, leis an Rialtas agus le gach éinne eile as an gcabhair a thug siad do dhaoine Chluain Meala cúpla seachtain ó shin when we had a very tragic time in Clonmel. I thank the whole community, the Clonmel school community, An Garda Síochána, all the agencies and all the people in the community and from around the country who rode in in the sense of the meitheal and supported those families. It was really deeply appreciated in the midst of our grief.

Clonmel town has a population of 19,000 and has a very large hinterland. It has fantastic industry. It is a town that is struggling with various issues but that has a strong community. It has a great business community that is doing its best in a very difficult economic climate. The Clonmel Business Network comprises more than 110 businesses - the small and medium businesses that are the backbone of the town's economy. However, the businesses of the town are at their wits' end. They are doing their best to trade despite the rising energy costs but are struggling to manage with an inadequate water supply. This not only affects businesses, but all of the householders, the hospital and anything else you could name as well.

As the Minister of State will know, I raised this matter with the Minister, Deputy O'Brien, during the summer and wrote to him about it a number of times. The town has suffered from weekly water outages, boil water notices and low water pressure. It is simply not acceptable in a modern network in modern times. You would think we were in a Third World country. I was in Bosnia and Herzegovina to visit Medjugorje recently. It is a very impoverished place but it has the best of water and broadband at all times. It also has none of the spin we have around here.

These water issues are costing businesses and householders. It is costing businesses thousands in additional costs and lost revenue. There is also the cost of equipment that is destroyed when the water goes off without the business being made aware. They have been forced to close due to the lack of water. Walking up the street in Clonmel, it is daunting to see so many vacant buildings. Businesses that were there for generations are now closed due to lack of business. It is even more depressing over the summer months when businesses close with a sign on the door apologising to customers for closing without notice due to a lack of water. It is a shocking situation. It would be okay if it happened occasionally. People would put up with that but this is ongoing. I salute the hardworking county council workers who are doing their best to keep the water in the pipes. They do a great job and have done over the decades.

It is quite simply unacceptable in modern Ireland that businesses should have to close due to a lack of water not once, but on 40 days since April. There are businesses paying thousands of euro a year to Uisce Éireann for water. They are customers but are left without any supply. No business could operate that way. I do not know how Irish Water is let get away with that. In my business experience, the customer is always right. They are not receiving adequate service and need urgent intervention.

The level of communication from Uisce Éireann over the summer has been appalling and the public representative line is simply not fit for purpose. The public is at a loss to know how we could have had the wettest summer in recent times, yet still have no water in the pipes, the houses or the businesses. It just beggars belief. I have been requesting a meeting with Uisce Éireann management and a visit to the three water treatment plants in Clonmel but have not had that meeting. We had an Oireachtas engagement meeting last week with updates but, in reality, the updates were very poor. We are to wait ten years for a proper supply. Water is to be taken from the River Suir and treated. In the interim, Uisce Éireann is talking about giving us hard water from the Moyle Rovers supply, a bored well. This will destroy the equipment of the rest of the town's householders and businesses because it is full of lime. Uisce Éireann, or Irish Water, has refused to treat it at source. We have very big problems. We have no confidence in Irish Water and want immediate answers.

Gabhaim buíochas leis an Teachta as an gceist tábhachtach seo. I thank the Deputy for raising this issue so that I can answer on behalf of our Department and for outlining the very real concerns he has put forward on behalf of the businesses in Clonmel. It is a town I am very familiar with as a former student of Tipperary Institute on the campus in the town. It is a town that is doing great work to revitalise its town centre, as the Deputy said, and this poses a great challenge to it.

The provision of wastewater and water services in Clonmel is a matter for Uisce Éireann in the first instance. The Uisce Éireann capital programme is fully funded, with almost €1 billion of Exchequer funding available in 2023. Uisce Éireann will have invested €134 million on water and wastewater infrastructure in Tipperary from 2014 to 2024 and estimates that approximately another €136 million will be invested beyond 2024.

My Department has made inquiries and has been advised that Uisce Éireann is monitoring the current Clonmel situation very closely. It has identified a number of projects to rectify many of the issues arising. As the Deputy will understand, these projects are complex in nature and may take some time to deliver. However, in the short term, Uisce Éireann is implementing remedial works for the three water treatment plants that serve Clonmel and its environs that will address deficiencies at the plants. Operational improvements are also being carried out with the installation of a generator with auto-changeover to enable continuous power to the plants in the event of power interruptions and control valves with automatic shutdowns. Uisce Éireann is also undertaking 2 km of water main rehabilitation for the Clonmel network, covering Cashel Street, William Street, Morton Street, Bolton Street, Albert Street and Western Park. Replacing these old pipes with new, modern pipework will improve water quality and supply as well reducing disruptions including low pressure and outages. These works are expected to be completed by the end of this year.

In terms of responding to the business community, Uisce Éireann has rolled out a new text alert system for businesses customers in Tipperary. The aim of this service is to inform business customers of outages, planned and unplanned, as well as drinking water restriction notices, including boil water notices, of a duration of more than four hours. If an issue arises on the network that causes a water outage in an area or affects water quality, businesses who sign up to the service will receive a text alert as soon as Uisce Éireann has assessed the issue and has the necessary information to alert the businesses affected and to let them know for how long they might be without water.

Furthermore, Uisce Éireann has advised that supports are available to business owners who experience issues with their water supply. Any non-domestic business customer who is impacted by a water quality notice will receive a tariff discount on their water supplied charge for the period impacted by the water quality notice. In this case, business customers will receive a 40% rebate on the cost of the supply of water to their businesses for the duration of the water quality notice and this will automatically be applied to their bills. Further information can be found on the business section of Uisce Éireann's website.

I will come back with a supplementary reply. The Deputy has raised very serious concerns but these are being addressed by Uisce Éireann. I know there was a briefing for Tipperary Oireachtas Members on the matter. I understand that Uisce Éireann is making every effort to resolve the issues. Again, we will relay the Deputy's concerns to Uisce Éireann from our Department.

I should have thanked the Ceann Comhairle for selecting this Topical Issue tonight. Uisce Éireann is not hands-on. It does not understand the pipe network or the reservoirs. It has a plan to stop taking water from the water treatment plant in Poulavanogue. It has laid a pipe 3 km up the road to pump water back up there. What it is doing is bizarre. It does not want to know and it will not listen. We have a reservoir up in the Ragwell. That is empty but should be used. Businesses did buy into the business network and text alert service the Minister of State mentioned but are not engaging with it because Uisce Éireann will not give them the reports. William Burke organised a meeting in the Clonmel Park Hotel, which I attended. Reports about these reservoirs and the water supplies were asked for but were not given. Businesses will have to make freedom of information requests. The contempt Uisce Éireann has for businesses, householders and public representatives is appalling.

I salute the councillors in Clonmel borough district area. They have been at their wits' end. Imagine having no water for 40 days during the summer when there are nearly floods in the river. The reservoirs cannot be filled in other schemes, including those in the Ardfinnan region, the Galtee region and the Lingaun supply in Carrick-on-Suir. There is water everywhere but the reservoirs cannot be filled because there are technical issues that are not understood and there are no technicians to fix them in time. The Minister of State's reply is useless, toothless and fruitless. When the caretakers were there - I salute one of them, PJ Cullinan, who went to his eternal rest last year - they were at the plants and understood them. Now they are looked at from a distance and by computer. The reservoirs have been less than a third full all of this year when there has been rain and more rain. Even tonight, they are a third full. There is something radically wrong with the systems when the reservoirs cannot be filled to maintain pressure in the pipes and supply the towns.

The Minister of State mentioned relaying pipework. We appreciate that is a help but the basic problem is at the plants and the lack of understanding of the system. It is new, modern technology and it is not fit for purpose. We have a spanking new plant in Orchardstown in Thurles, only fitted two years ago. Thurles had a boil water notice for 40 days recently, so all the investment is not working. It is about going back to the drawing board. Unfortunately, Irish Water is not fit for purpose and it does not listen to the people or the businesses.

It would appear to me, having just listened to the debate, that it is not an unreasonable request to ask Irish Water to engage with its customers in Clonmel.

It is a public utility paid for out of the public purse.

I agree wholeheartedly. In fairness to Uisce Éireann, it has engaged on this issue. My understanding is that there has been a comprehensive written update issued to all local public representatives this month, setting out-----

-----Uisce Éireann's investment for Clonmel and its communication strategy and engagement practices with local elected representatives. My own experience has been that this is improving, and has been improving, particularly over the last year. I also understand that Uisce Éireann has provided comprehensive details on the Clonmel outages to the Clonmel business association last week, and further, provided briefings to Oireachtas Members and Tipperary County Council water services at a workshop last week. This is more proactive. I know historically that Deputies have raised issues around Uisce Éireann's communication but I think it is improving. Deputy McGrath will challenge that but I think it is improving.

Regarding long-term plans, Uisce Éireann is running a public consultation on the regional water resources plan for the south-east region, and this includes part of Tipperary. The plan sets out options for providing a more secure, reliable and sustainable water supply for almost 370,000 customers-----

In ten years' time.

-----in the south-east region for over the next 25 years. Feedback is sought through the public consultation on the draft rural water programme, RWP for the south east. I reiterate that it is critically important, as the Ceann Comhairle said, that the channel of communication between Uisce Éireann and its customers - in this case, the business community in Clonmel town centre - is effective, meaningful and addressing the issues as they see them. I think that is happening but I can appreciate the challenge that it has brought about for the business community in Clonmel.

I appreciate that response and I thank the Minister of State.

General Practitioner Services

I thank the Ceann Comhairle for giving me the time, at short notice, to get in on this important issue. There is a fundamental problem with GP care around the State, and particularly in Kerry, although this is not necessarily related to a Kerry issue. We have had our own problems in Kerry finding doctors for towns and villages like Ballyduff, around the Ring of Kerry and a few years ago in Milltown. Essentially, GP care is privatised and many GPs and the HSE have to settle terms to provide care in communities.

From time to time, the old Tralee Town Council instituted a scheme to help emigrants, Irish people who had been England for 30 or 40 years, to return home. It was in dealing with the Safe Home group, which is based in Mayo, that this difficulty came to pass. Many of these people sent remittances home. When times were very difficult in Ireland, they kept the country afloat and it is very important that we take care of them. One such individual contacted us, and the organisation Safe Home had received an email saying that at the moment, they could only advise that they should keep contacting GPs in the area because the HSE no longer assigns GPs to clients. The email said that for any further queries, an 0818 number could be contacted. For years, it was standard practice that if you had tried and was refused by three GPs in an area, the HSE would then step in, help you out and try to find a GP. This is very important for people in general but more so for Irish emigrants who are coming home. They may have been living in council or trust accommodation in Britain and are coming home. They may have a place arranged here but they need a medical card. One needs a medical card, as the Minister of State, Deputy Butler, knows, for carer's allowance, housing adaptation grants, the HMD1 housing form, or for people with additional needs. A GP and a medical card are needed to understand that and to get into the system, so to speak.

I know that many GPs are under pressure as I have seen in my own county, and no doubt the Minister of State has seen it in hers. However, there is a serious problem. The Sláintecare recommendations have not been implemented. Obviously GPs are under pressure but the HSE is in charge of this whole policy, and really it should be stepping in. Vulnerable people who are returning home after many years abroad should be looked after. It is morally right, and it really should be encased in legality. Will the Minister of State be able to do something about it to ensure that this is not going to happen to any more vulnerable people?

I thank the Deputy for raising this issue, which is a matter of major concern to the individuals involved. Patient choice of doctor has been, and continues to be, a bedrock principle of the general medical services, GMS scheme. For the vast majority of individuals, their choice of doctor is accommodated and they are registered on the GMS panel of their doctor of choice. In 2022, which was the last full year of data available, out of a total of about 348,000 individuals who were approved for either a GP visit card or a medical card, 3,927 individuals were unable to secure placement with their doctor of choice, or 1.1% of the total. In addition, 3,701 existing GMS patients were reassigned following a change in their place of residence.

While recognising the difficulties this can pose for individual patients, it is fair to say that the extent of the challenge is relatively small in the overall scale of the GMS service provision. However, I acknowledge and accept that for that small amount of people who are finding it difficult, it is very challenging. For those individuals who are unable to locate a GP, a long-standing process is in place in line with the contractual arrangements, whereby individuals are enabled to access GMS services from alternative GPs, either by agreement with individual doctors or through the patient assignment process. In line with these arrangements the HSE may assign an eligible person to be included on a medical practitioner's GMS list.

It is important to confirm that this process whereby the HSE can, under the provisions of the contract, assign patients to GPs remains in place. However, in the period between 1 July to date - this is what Deputy Daly is referring to, that is July, August and September - the HSE was obliged to exercise caution around the application of assignments, dealing principally with urgent and priority cases in advance of the new arrangements that are now being implemented following the agreement with the Irish Medical Organisation, IMO reached last June.

In the context of the learnings from the operation of the existing arrangements, and having regard to the implementation of the extension of eligibility of GP visit cards to include under-8s and those on no more than the median income, it was agreed with the IMO as part of the GP agreement for 2023 to flex the existing arrangements with a view to ensuring an equitable and fair distribution of patient assignments to individual GPs and across geographies, for example, not putting 30 with one and one with another.

In addition to the foregoing, a joint HSE and IMO working group is being established to review the operation of the patient assignment protocol to ensure that it is framed and operating in a fair, equitable, patient- and GP-centred manner and that due regard is given to health and safety considerations regarding GP practice teams, as well as impact on patients in terms of how it is being operationalised.

In response, there has been an issue in the last three months but now it is being resolved in such a way that it is fair and equitable for patients. It will be interesting to see how it will work out going forward. I am aware of some of these cases as well, which came through my own constituency office and I know exactly what the Deputy is talking about regarding people who might have relocated from another country.

I thank the Minister of State for her response. This is something that came to the attention of Safe Home Ireland on 15 September. I am not sure what arrangements have been in place since the end of June or the beginning of July but this is a category of people who are the most vulnerable and who are returning after many years abroad. Irish citizens cannot get a GP card. How is that fair or equitable for people who were forced to emigrate in the 1960s and 1970s? They spent their working lives abroad and now want to come home to spend their final years in Ireland.

It sounded to me that what the Minister of State said in her response about flexible arrangements with the IMO was leaving someone off the hook. I am not sure if it is the IMO or the HSE. These are cases that should be prioritised. There are recommendations in Sláintecare about directly employing GPs. Perhaps alternative arrangements need to be considered because clearly it is not working. It is not working for someone who is most vulnerable and in the latter years of his life. He might have expected a welcome home but he is not getting that. He will be unable to access a whole load of other arrangements. I can give the Minister of State the details of this organisation and the individual concerned. Perhaps something could be looked at for him. Going forward, a policy must be put in place whereby people who qualify have a right to GP care. Any other way is unacceptable.

I probably should have read the concluding statement first because it contains better news. I again thank the Deputy for raising the issue. I appreciate the concern and the issues he has raised, with which I am familiar. While some persons may have been advised recently that the primary care reimbursement service, PCRS, would no longer assign any medical cardholders or GP visit cardholders to a GP or general medical services, GMS, panel, as per the previous practice, following the short period whereby urgent assignments were prioritised in advance of the new assignment arrangements, the HSE has confirmed that the assignment process for cardholders is, as of today, back in place. I thank the Deputy for tabling the question. The GP agreement 2023, which was announced in July, does contain assignment arrangements on the assignment of patients to GP panels. However, these arrangements do not prevent the assignment of patients and rather are there to help ensure equitable distribution of assigned patients to GP panels.

The good news is that as of today, the HSE has confirmed that the assignment process for cardholders is back in place. The second piece of information is that the GP agreement will look at equitable distribution of assigned patients to GP panels, which I think everybody could understand. Further to confirming the continuance of the assignment process, as mentioned, the agreement provides for the establishment of a working group which will review the operation of patient assignment to ensure a fair system that has regard to individual GP practices.

The situation for July, August and September has come to an end as of today. It will be business as usual to assign the 1% of people who may not have a doctor. The GP arrangement panel will look to help ensure equitable distribution across all GPs.

Care Services

I thank the Minister of State for being here a little after 11 p.m. It is heartening to see her here so late to talk about this issue, which she knows is a major problem in my area, the constituency of Cork East. We need to see an enhancement of facilities for the elderly in the east Cork area. The area is growing rapidly. It has a certain characteristic. Unlike many parts of the country, we are lucky to have a beautiful coastline. There are towns in the area to which people come to retire in later life. Youghal in County Cork is an important example of such a town. Those who come to the area are in addition to the thousands of retired people already living across the east Cork area. However, there are no day care services for the elderly in Youghal. I know that the Minister of State's Department and the area in which she has responsibility has been provided with a significant amount of funding to provide such services and facilities. I am here tonight to ask the Department to identify the potential in Youghal for an enhanced service for elderly people, particularly through the provision of a day care service.

We are lucky to have diligent workers in our healthcare settings in Youghal and Midleton, the two primary towns of the east Cork municipal district. I am conscious that there are people who need that support and who may not have the full independence and luxury of being in their own homes, which many people are deeply fortunate to enjoy right up until their passing. Many people have that independence into their 90s. However, we must remember those who need a bit of company and support. They might not have children to look after them. They might not have large families. We must ensure there is wraparound support for them. That is why these services are so vital. It is also worth looking at the areas in which these services are provided. They are fundamentally positive services that the State provides and I have never had a complaint from those who partake of them in other areas where they are available.

The Minister of State, because of her hard work in this area, will be aware of why this is so important. I would like to see some focus on this issue. I know that such a service would have an enormous impact in Youghal. The Minister of State's constituency is just over the border in Waterford, across the Blackwater River from Youghal town. We are looking across at the Déise from Youghal town. There are many people in that area who would benefit from such a service. People in places such as Ardmore, Clashmore and Knockanore, which are areas in the Minister of State's constituency and she serves them well, must travel a greater distance to Dungarvan or Lismore, which are the next closest towns. They are part of the Youghal community. Their children and grandchildren have gone to schools in Youghal and they are part of our wider community despite being in a different county and Dáil constituency. We have a mutual interest that this problem is identified and tackled. From a health infrastructure point of view, Youghal feels a little neglected. I am here tonight to advocate on the town's behalf and to see if this is a matter with which the Minister of State could help.

I thank the Deputy for raising this important issue. I welcome the opportunity to discuss day centres because they are such an important provision for older people. Almost 300 day centres are currently back in operation. During the Covid-19 pandemic, we did a risk assessment of each day centre the length and breadth of the country to ensure they were complying with infection prevention and control measures. It is great to see that. In the next two weeks, I will be in the Deputy's constituency when I will open the Mallow dementia-specific day centre, which will be the 50th dementia-specific day centre in the country. We have made a lot of progress.

As the Deputy knows, a key focus of our Sláintecare reform programme is recognising the need to enable older people to age well at home and in their communities. In order to do that, I always speak about the triangle of supports we need to provide, which is composed of home care, day care and Meals on Wheels. Those are the three most important things and working in collaboration with each other, they make an important difference to the life of an older person.

There should be no doubt that investment in social care and home support has been a substantial priority for me and the Government. In May this year, I was delighted to announce the allocation of €5.25 million in funding for Meals on Wheels and day centres for older people. In addition, a further €2.1 million was secured for dementia-specific community day services.

There are currently 397 people in the east Cork area in receipt of home support, equating to just over 2,040 hours per week. There are three HSE-funded Meals on Wheels organisations providing more than 1,200 meals to 112 clients per month. There are also three day centres operating in east Cork, as the Deputy knows. Midleton day care is a HSE-operated day centre currently operating Monday to Friday. It provides day care to 98 clients per week. The Alzheimer Society of Ireland operates a dementia-specific day care on Saturdays for up to 12 clients. Cobh day care is currently operating Monday to Friday from 9 a.m. It currently provides day care to 63 clients.

As the Deputy has said, Youghal does not currently have a day centre for older people but plans have been proposed to develop this service for the area.

When I realised recently that Youghal did not have a day service, I was more than surprised. It is a big town with a large catchment area and the nearest day service to it is a full service in Dungarvan, County Waterford, and there is a smaller day service in Cappoquin. In the areas which the Deputy has mentioned in west Waterford and all of the way into Youghal, which is a very significant catchment area, I was surprised to learn there is no day centre there. I want to work with the Deputy to ensure that we can put a service in place because, as I said, it is instrumental to support older people to age in their own homes.

A proposal has been drafted and an order of magnitude cost has been produced for the redevelopment of the St Raphael’s healthcare campus. This proposal includes plans for a day centre to be incorporated into the refurbished main building. My concern, however, is that will take too long. I am not over the detail of the actual building but with the winter coming, I would hope that we might be able to work on a temporary solution while this is being put in place. At this stage, it is not possible to determine a timeline in respect of the establishment of a day centre in Youghal until capital funding has been sanctioned for same. At the same time, while there is a major refurbishment going to proceed at that healthcare campus, I do not believe the people of Youghal should have to wait for a day centre. It is so important and even if one was to start off with a three-day service and build up to five days, that would be very important.

I welcome the Minister of State's response and I understand the point she has made on Youghal's population and size and not having these services. This has been a long-standing problem and issue in Youghal. For many years the town has been without Deputies and I am lucky to be the second person elected since the 2011 general election; we also had Deputy McLellan. I am very honoured to be elected for Cork East but coming from Youghal and having that familiarity with the community there, people feel very much abandoned when it comes to infrastructure. It is the end of the road before one goes into a different local authority area in County Waterford. I am heartened that the Minister of State has an understanding and appreciation-----

There is nothing wrong with the Déise either.

Yes, but as for the county boundary, trying to get that intervention from the State at a local authority level is an issue of continuing concern.

I want to see the Department of Health putting in further focus and examination.

One item of further concern regarding primary care services in Youghal is that a number of plans have been proposed for the St Raphael's site and it is important that something be done with it. It is a State-owned building and it is very lucky to have a very wide, expansive campus there. There was a great deal of hope that it would be the location of the new primary care and acute hospital facility being provided in Youghal but the HSE obviously is looking at it as being an older building and analysing whether it is more appropriate to construct a new facility on a greenfield site. If it is the case that the HSE is no longer interested in operating the older disused building in St Raphael's, not the newer facilities, it should look to releasing the older facilities to other State-owned and State-run facilities in the community.

This should include Gaelscoil Choráin, a wonderful Gaelscoil under the management of Caitríona Ní Riada, our principal there. That is a school which is very tight for space. That is just one small example of a community organisation that could take up use of St. Raphael's if the State thought the old building of the old psychiatric hospital there was no longer fit for purpose for healthcare provision but could be transferred to the use of something else. Extensive modern facilities have been built there and I would like to see whether it is possible to look at that being used for other purposes together with the daycare facilities. That is just one good example of why this site could be used for community purposes once again, having moved on from the style of psychiatric care that is no longer being provided in the country for obvious reasons where our best practices and models have moved on. That facility is very old and rundown.

Gabhaim buíochas leis an Teachta. Every week I see the importance of and the vital role played by community support in helping older people to stay living at home independently and to age in place in their communities. If one speaks to anybody in Ireland, all they want to do is to be able to remain at home for as long as possible. I am very proud of the fact that, being Minister of State with responsibility for mental health and older people, Ireland has the highest life expectancy in the whole of the EU, as deemed by the World Health Organization. We do the social care model very well. I continue to be committed to working to develop these services to ensure they are available where needed across the country. They are needed in Youghal.

One thing I have always put a focus on since I was appointed Minister of State was the postcode lottery. Day services in a town the size of Youghal in that part of the country are very important because the town has a large catchment area. Even though there are fantastic supports in Midleton and in Cobh; these are too far to travel to for some people.

I would like to see us getting a service up and running as quickly as possible and I want to work with the Deputy on that. I understand that whatever the HSE will propose on that site would be state-of-the-art but my concern is that that will take quite a while. I would like to see an interim solution in the meantime perhaps even, as I noted earlier, starting with three days a week in order that older people living in the Youghal area could have access to a day centre. The day centre is so important post Covid with regard to the amount of loneliness and depression being experienced. People love meeting up with their friends, having the nutritious meal and all the supports that are provided, whether it be music, cards or activities. This is something I am not going to walk away from tonight and I am going to push this very hard. It is very important. There are a few areas I have pinpointed that need day centres and Youghal is one of them.

Cuireadh an Dáil ar athló ar 11.17 p.m. go dtí 9.10 a.m., Dé Céadaoin, an 27 Meán Fómhair 2023.
The Dáil adjourned at 11.17 p.m. until 9.10 a.m. on Wednesday, 27 September 2023.
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