Jennifer Carroll MacNeill
Dún Laoghaire · Fine Gael · Ireland
“It will be provided by a registered pharmacist in accordance with the relevant pharmacy legislation, including this Bill. Section 2 of the Bill makes various amendments to the Irish Medicines Board Act and the Pharmacy Act. Those amendments ensure that whole legislative framework is cross-referenced correctly.”
“We now have a common conditions service where you can go to a pharmacy instead of a GP to get a diagnosis and prescription for eight basic conditions like conjunctivitis or urinary tract infections - the kind of things that just come up in people's lives all the time. We would like to expand more and more what pharmacies can do.”
“In particular, the board will be focusing on aspects of menstrual health, on aspects of postpartum mental health, particularly in traumatic birth cases, on something we have overlooked for some time, which is endometriosis, on women who are finding it difficult to access services in different ways, as Senator Harmon suggested, and on more…”
“The extension to 41- to 45-year-olds could possibly be €5 million to €8 million because there are statistically fewer women in that bracket trying to conceive, so the numbers are higher. It really is a question of funding. I remind Senators that they have also asked me to fund various other programmes.”
“That followed confirmation from the Pharmaceutical Society of Ireland and the Health Products Regulatory Authority that the patch and ring are classified as medicinal products, not medical devices. That is just a correction there.”
“That is why we have put so much money into supporting them in different ways, including the conclusion of a €50 million increase to their fees and to provide for the opportunity to raise private funds in this way, for example, the common conditions service. I want to see pharmacists doing more.”
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“I would be very grateful for the specifics of what the Deputy is asserting. I will check that out. It is very much the opposite to what we are trying to do. Considering the number of vacancies we are desperately trying to fill, I would be very concerned about that. I would appreciate if the Deputy could help me out with more information on that. Several cancer centres have plans for additional theatre and inpatient capacity specifically for cancer and inpatient care because the theatre access is so important. Part of what will help with this is completion of the surgical hubs nationally, which will alleviate some pressure on our acute theatre capacity by moving lower complexity procedures, obviously since it is surgical hubs.”
“As part of the productivity we were speaking about, this is an example of why that matters so much. Access to imaging, as far as I can see at the moment, really is the most challenging part.”
“The five-year net survival rates for breast cancer grew from 71% in the 1990s to 87.5% for the 2019 to 2022 period. We are going in the right direction. The Deputy is absolutely right to highlight it. We have had more people through the system and demand is increasing year on year. More than 56,000 patients were seen in clinics in 2024, up from 50,000 in 2019. From my analysis, the single biggest issue, although there are many, is the timely access to MRI as a diagnostic tool. From the data I have, the reason for being out of target, say in 2022, was that imaging was at about 30%. It is now at 41%. We need to focus all of our efforts on access to imaging, the way in which our imaging technology is being used, the consistency, the hours that it is being used and the commitment of hospital staff to do that at all times and days of the week.”
“The HSE is working on several initiatives to improve surgical capacity, including consideration of imaging and inpatient capacity in several cancer centres. Waiting times for radiology and diagnostic services are very seriously recognised as an issue. The NCCP has produced a range of guidelines aimed at ensuring standardised access to cancer services across the country. These will, I hope, reduce variation in the management of patients and will lead to more appropriate referrals and management of patients within cancer services. The Deputy will already be aware of the scale of the investment into the national cancer strategy since 2017. Significant improvements have been made with regard to breast cancer in recent years, in line with the overall objectives of the national cancer strategy.”
“The Government is of course, as is everybody else, committed to improving cancer care, ensuring better prevention, maintaining improvements in cancer survival rates, and timely access to treatments. The national cancer control programme, NCCP, has a number of metrics for breast cancer services. They are consistently reviewed to guide service advancements and to make improvements. Since 2017 the total number of patients annually receiving this type of surgery increased by 10% to well over 1,500 in 2023. Over this period the percentage of patients seen within the recommended 20 days has decreased from 84% to 60%. The time to surgery can be influenced by a number of factors, including imaging and inpatient capacity, as well as the individual circumstances of the patient.”
“I cannot account for the reduction in the number of families travelling abroad. It is not clear to me how that is being offered to them, at what stage it is being offered to them or the breadth with which it is being offered. I am pleased that the adolescent complex surgeries have begun in the Mater. This is after a period when they were being paid for and not being done. Since July it has now been agreed that these will be done, and I am trying to see what options I have, domestically and internationally, that go beyond what we currently have to see how we can do more. I will report back to the House on that. I do not have an answer on that yet.”
“Again, I agree with the Deputy. On the Dickson report I will provide a note to Deputies on this. There is a follow-up process with those families. I do not have the details to hand but I would like to provide that information to them. Deputy Cullinane is absolutely right about developing services now. An inquiry should not prohibit or preclude that. He will be aware that I have strengthened very considerably the board of CHI with appointments most recently, and in particular with Fergus Finlay who is a very strong advocate in this space, and who I know will be a very strong advocate on the board and hold CHI very strongly to account, especially in relation to spinal services. As I said at yesterday's health committee meeting, I am really not satisfied with this year's performance.”
“Again, this is for a discussion with the advocates and with the person who will, ultimately, be in charge of this. It will be intended to have a senior legal figure and a clinical leader of this inquiry. It is very important that we get their perspectives as well on what is likely to work, what is going to be the right timeframe, what is capable of being comprehensive, and not precluding other proceedings that may be appropriate.”
“Yes, it would be my intention, irrespective of the form of investigation or inquiry, that it would be comprehensive in the way the Deputy has outlined, that it would be transparent and that it would be an inquiry that is also capable of making recommendations, as the parents and advocates have looked for. As he will be aware, in some forms of inquiry where information is presented during the inquiry, it can never be used in other proceedings. I am very conscious, for example, of a comparable model in relation to Limerick where there are disciplinary proceedings happening. That has never happened in the health service before. The Frank Clarke report did not step over that, but a different form of inquiry would have stepped over that and precluded some of those disciplinary proceedings continuing. That is the balance I am trying to strike.”
“There is also the CHI oversight improvement steering group which is working regularly and oversees the implementation of the range of different reports of which the House is already aware, including the HIQA review. It will also oversee upcoming reports, including the Nayagam review, and a range of other measures.”
“I have committed to scoping out the different models that are possible and the pros and cons of each of those models, while recognising that some of them have limitations, and to presenting that back to the parents and the advocates. It is important we would have a follow-up meeting when they have had the opportunity to reflect on that therefore it is my intention to write to them within two weeks and then to meet them a week after that. I have a little bit of work to do on that yet. The inquiry will be part of the wider reflection on paediatric services in CHI. The Deputy and the House will be aware that there is an important audit going on into waiting list equity or equity of access to the waiting lists in some of these services. It is important to say that.”
“I thank the Deputy. He is correct. On Monday, the Tánaiste and I met with the parents of Harvey Morrison Sherratt, along with other advocates who were there to support the family. The Tánaiste and I listened carefully to what his parents said. It must have been a particularly difficult time, as all of this period has been for them, but also recognising it has been two months since the death of their little boy. At the meeting, it was agreed that we would work in partnership on the structure of an inquiry into spina bifida and complex scoliosis services at CHI. As the Deputy will be aware, there are a number of different models of inquiry and investigation.”
“We hope that planning permission will come through for the other 96 beds very shortly. Our first priority and, as HIQA analysed, the most important thing is the inpatient acute bed deficit in Limerick hospital. That has to be our first priority.”
“I thank the Deputy, and indeed many Deputies who have raised this issue with me. The HIQA report was published by HIQA just this lunchtime. It is a comprehensive report, 1,200 pages, looking back into the demographic issues in the area. It gives three options. The first two are loaded in terms of giving acute beds in the hospital. The third option, C, is the longer term option of a model 3 hospital. HIQA itself prioritises options A and B as meeting the needs of the people in the most immediate term and says that option C, the model 3 hospital, would take a very long time, cost a lot and not meet the needs in the interim period. In the first instance, therefore, I am pleased to say that 96 beds will open this week into next week and we will be there to formally open them in October.”
“The Deputy will be aware that I updated the House in May that HIQA had looked for an extension of that timeline, and intended to finalise the report in September. I can confirm to the Deputy that I have not received it from HIQA yet. It is the intention of the Government to examine the recommendations of HIQA and take them extremely seriously. I have not seen it and have not received the report yet.”
“What is not happening is that this is not translating from a patient flow perspective into making sure the patients are safe and the staff in the emergency department are appropriately supported to make sure they can do their jobs in the way they need to do them. We will stick with the facts here. It is not understaffed; it needs to be balanced.”
“The hospital is not understaffed but it has an understaffing area in the emergency department, specifically because it is not being correctly staffed on the other side. I asked Bernard Gloster for an analysis of this and I have the data back. It is my intention this week to write to every TD and councillor in Mayo to specifically outline exactly what the staffing issues are, exactly what the patient flow issues are - which are a whole-of-hospital responsibility - and what we need to do within Mayo to make this better. Let us not confuse ourselves; this is not a staffing issue in Mayo hospital. It has one of the best staffing ratios of all of the model 3 hospitals.”
“Mayo University Hospital remained red all through August, which is completely unacceptable. Last weekend, there was not sufficient work being done to discharge during the weekend. There were 16 discharges in the hospital on Saturday, there was one on Sunday and there were 47 on Monday. I ask the Deputy to explain that to me. There is not a single person in this room who can explain that except that there is an imbalance in staffing. I was there on a random Saturday in August and the emergency department was absolutely overwhelmed. There was a serious patient safety issue there. The rest of the hospital was completely empty. There were practically no diagnostics going on. There were not even people in the diagnostics area.”
“How? Let us discuss Mayo University Hospital. The first thing is in relation to staffing. Mayo hospital has had a 30% increase over the past five years. When I saw some of these figures I did an analysis of a sample of nine model 3 hospitals. Mayo hospital has the second highest rate of staffing of those model 3 hospitals. The difficulty with Mayo hospital is not the level of staffing. I have also included a maternity leave analysis and a sick leave analysis. Mayo hospital is not understaffed. However, Mayo hospital is imbalanced. I will give the Deputy two examples of that. I was there on an unscheduled visit when there were 47 patients in the emergency department. Of those patients, 20 had been admitted for beds, but there was no discharging going on up the hospital.”
“I am grateful to the Deputy for raising this matter. I will discuss it with the chief medical officer. Perhaps, the Deputy will share with me some of the correspondence that he referenced. We are very keen to ban all the inhalation products that we know are bad for people. We are trying to get ahead of that, never mind catching up with it. I would very much welcome a conversation with the Deputy and we will see what we can do to progress that.”
“I thank the Deputy. Yes, he wrote to me on this issue and we wrote back. A number of months ago, the Deputy sought confirmation that this was going to revert to a community nursing unit. Obviously, we are discussing that is now happening. There are a number of administrative arrangements that need to take place. Let me not comment on Bartra Healthcare and the transfer of undertakings, but what I can say is that there is active recruitment across the HSE in all cases to try to bring more people in. I responded to the Deputy privately on this matter. We are desperately seeking more and more people to apply for positions within the HSE. We want to employ all of those people, whether by transfer of undertakings or by means of a different recruitment process.”
“I really would like to speak about the human rights strategy for disabled people but I appreciate I have used my time on that matter. It is important.”
“This is why I have asked Bernard Gloster to commission a specific audit into three practice areas in CHI, two of which are to be surgical - one neurological, one spinal services and one other medical profession to be determined by the auditor - to examine exactly how these pathways are occurring, exactly what is happening, and how people are referred to different processes or not. I have also put in a strong qualitative element to try to understand and be able to talk to parents on how it is that this was referred to them or that was referred to them, but not this or not that, to try to get a much better picture. I expect to have that audit by the end of November or the beginning of December, subject to the auditor.”
“On restructuring the theatre plan, because of the capacity of the new surgeon to do more work and seeing what we can do with additional theatres in Cappagh, though I would have expected this to have been done already, I have examined the reasons for the cancellation of surgeries - literally all of the reasons for the distribution and why surgeries were cancelled because of a clinical reason, a matter within the hospital or a parental matter - and looked through those different reasons and tried to understand it better, but I cannot overstate my frustration with this.”
“I am not satisfied with the international referral pathways and have lots of questions about why there is a decrease in international pathways and an increase in referrals to Blackrock. Some of the measures that we are taking to try to address the waiting management of it is a centralised management of dealing with cases and key workers to be able to respond to parents. Though I am not satisfied that neither of these things is in place today, I am told that they will be done by the end of September.”
“Though we are doing more outpatient clinics on Saturdays - this year there have been 16 - which has resulted in an increase in the number of patients referred for surgery through better diagnostics through attending to people at an earlier stage of the order of an additional 700 as a consequence, we have recruited a new surgeon who began on 11 August, and we have put in more resources time and time again in terms of MRI machines, theatre capacity and additional human resources, I am still not satisfied with the timelines for surgeries or the referral pathways identified for 2025. It is a matter of fact that the 2025 plan that was received to the Department in relation to the surgical spinal plan was sent back as not being sufficient.”
“It will only be final once it is agreed and discussed and we have had the opportunity for Bernard Gloster, at the family's convenience, to agree a timeline of care. It is not for us to determine that by ourselves; their voices must be heard. I will also meet with Harvey's parents, Gillian and Stephen, with the Tánaiste shortly. We will continue to drive improvements to try to get a better service in CHI. While we are here to speak about the national human rights strategy for people with disabilities and I would like to discuss that, I am conscious that when we speak about disabilities there are a group under the care of CHI for whom we are not, in my opinion, delivering timely enough services.”
“Before I begin speaking on the national human rights strategy for disabled people, I want to take an opportunity to reflect on the far-too-short life of Harvey Morrison Sherratt and to extend my sincere sympathies in the Dáil to his family, Gillian, Stephen, Lyla and Remy, and his extended family. The pain felt by those around Harvey can never be eased. What we can do now and are determined to do is to drive change, but I do want to acknowledge that. In the weeks since Harvey's passing, I have asked the HSE CEO, Bernard Gloster, for a timeline of Harvey's care from a multidisciplinary perspective. I have received a draft, but we do not regard it as a final complete document until his parents have had an opportunity to feed in their perspectives.”
“It had very poor hospital trolley performance over the bank holiday weekend in early February, but it has been consistently difficult. It had a significant uplift both in resources and staff, but I am concerned about its weekend management. Not to be too unfair to Mayo, but the point is that there are different nuances in every hospital and we need to be honest about this. This Bill is important because it helps to do one thing, that is, to be focused on corrective action. That is the sort of granular detail that we will need to improve financial performance in the health system.”
“I do not want to do it in a way that will cause waiting lists to spike, not because Deputies are going to correctly hold me to account for the waiting lists but because I do not want people to be in difficulties. We will have to find the right way to bring down the activity that we do not believe serves the public interest in the medium to long term, that is, third-party insourcing and so on, and to increase productivity. Both are granular challenges which will be difficult and are complex. I need Deputies' insight, help and analysis and to use all of the tools of the Oireachtas to help to analyse the nuanced performance of hospitals that I have spoken of today. Deputy Conway-Walsh referred to Mayo in particular and I am interested in Mayo because it was one of the first hospitals I visited.”
“It was the correct set of decisions to take every step possible to reduce the waiting lists because that results in people getting pain relief, elective procedures and diagnostic tests that they need. Over the next 12 or 24 months, as we decide to do this, we have a real challenge in making sure that capacity is delivered in the hospital system. I would welcome the support and help of the health committee in particular in analysing the performance of hospitals in this way and making sure that we are winding down a structure we know is legitimate and lawful but is not what we want and not what we believe is the correct thing to do.”
“We have, together, a significant issue to manage, and which Deputies identified, with regard to insourcing. I believe it is not correct or moral for the State to continue a system which it knows is creating a barrier to achieving productivity in the public system. I am completely committed to a public health system funded by the State and delivered for public capacity, and to having that public work done in public hospitals. I recognise that there are historical contracts that enable consultants under certain contracts to do private activity in certain spheres. I recognise that that is so. On the other hand, I also see that 65% of consultants are now on the public-only consultant contract. We want public activity.”
“It is not acceptable for a hospital to make the case for an additional CT machine or any other diagnostic equipment in circumstances where that CT machine is not being used for all of the hours that Deputies and I expect it to be used. It is not acceptable to have CT machines or other diagnostic equipment which is not being used beyond 4.30 p.m., as is the case in some hospitals. I go in and ask what time the CT machine runs until and I am told it is maybe 8 p.m., maybe 5 p.m. or maybe 4.30 p.m. That is not okay and it is not okay for the State to be required, or have pressure placed on it, to put additional CT machines somewhere that one is not being used to the optimum capacity. Those are the savings and productivity necessary to deal with the sort of service we want to deliver to patients.”
“There was significant and necessary investment. We historically underinvested in health, particularly on the capital side. I thank every Deputy who has made the case for a large envelope to be given to the Department of Health and the HSE in the review framework, recognising the difficulty of managing that process overall, because of course all hospitals need water and energy security. Those things are also important but there needs to be significant capital investment. I appreciate the recognition of that. We cannot continue to grow the current budget the way it has been growing. We have invested in people and hospitals. We must get the return for that investment.”
“In circumstances where bills for external consultants or legal advices outside of the State structure are still being paid or where, for example, there has not been evidence of non-pay savings over a three-year period, it is a bit like taking a dead cat and saying "Now, Minister, give me a big pile of money or else." We have to be serious about hospital management and about money being spent in a consistent and predictable way. We have to do that collectively and identify the instances where that is not happening. There is unfortunately too much variance between hospitals and in how we think money should be spent. The budget has increased. In 2013, the health budget was €13.5 billion. It is now €25.8 billion. In a ten-year period, we have essentially doubled the health spend. We as a State cannot do that again.”
“The CEOs are now required to notify me or the Minister for Health of the overspend and to identify the detail of what caused the overspend and how it is proposed to avoid the overspend. The board can then review that, amend or approve proposals, agree on the cause, and agree on the actions that will eliminate or reduce overspend which it believes are practicable. None of that applies at present. There is a different level of detail in managing spend and overspend. It should not be the case that there are threats or assertions that a body cannot pay its pharmaceutical bill or its revenue bill and must close beds because all of those things are completely unacceptable, outrageous responses to a failure to manage a budget.”
“A couple of weeks ago, however, it was one of the hospitals on a list of hospitals that were in considerable difficulties. It had closed the Smithfield injury unit for the bank holiday weekend, which it has been paid to operate under the service level agreement. These are inconsistencies which are not acceptable and which we cannot stand over but they speak to the level of detail and nuance that is necessary to understand the complexity of health budgeting and how that is being translated to patient care on an individual basis. While I appreciate this Bill does not transform the world, it does a couple of really important things that we need to happen. That includes in particular the corrective action plans, CAPs, that are necessary.”
“I pulled the figures out for Waterford as Deputy Cullinane was present a minute ago. Waterford hospital has an average of zero people on hospital trolleys in 2024 and 2025. It has also had a 44% increase in staff, but with a different outcome compared to Kerry hospital. If I take St. Vincent’s University Hospital, which is the closest model 4 hospital to me, it has had a 35% increase in staff and a 59% increase in budget. Yet, it has an inconsistent performance in its accident and emergency department and its management of delayed transfers of care. All of these particular local nuances matter. The Mater hospital, which I visited last week, has been good enough on its accident and emergency management. It is the rest of the hospital’s responsibility to support the accident and emergency department.”
“This is only one particular example that happens to relate to Kerry because Deputy Healy-Rae was the last speaker. I could equally speak about Cork and the figures for that area. Although Deputy Healy-Rae was not in the Chamber when I was pulling the information together, with regard to Wexford, the constituency of the Ceann Comhairle, staffing numbers have increased by 21% over the past five years. There has been a 22% increase in medical staff and a 33% increase in nursing and midwifery staff. Wexford hospital is performing extraordinarily well with a much smaller increase in resources. It has low hospital trolley figures. Its culture is one of whole-of-hospital management. It is doing really well. It certainly needs more investment and support, but it is performing extremely well.”
“In May, there were 13 days on which there were zero patients on trolleys in Kerry hospital. There were three days on which one patient was on a trolley. May was, therefore, a good month. It shows there was bed capacity and management of the hospital in the round. The considerable extra staff meant there was good management of the emergency department. Something happened in June, however, and the figures were the complete opposite. This is the nuance of hospital-by-hospital level experience. The Deputy set out exactly why this is so important. It is about the dignity and safety of patients who should not be waiting for 24 hours. They should not be waiting for more than six hours. Of those people who present, only 25% of them need to be admitted and managed in other pathways.”
“Deputy Healy-Rae has helpfully set out the difficulty with regard to hospital beds. Let us take Kerry hospital as an example. In the context of staff numbers, in the past five years, Kerry hospital has had an increase in staff of 43%. It has had a budgetary increase of 67% in the past five years also. To provide the breakdown of that staffing increase, Kerry hospital has had a 52% increase in medical staff; a 44% increase in nursing and midwifery staff; a 74% in patient and client care staff, who are the support staff; and a 43% increase in health and social care staff. Those are significant numbers. Kerry hospital is perplexing me at the moment. In May, it was one of the best performers in hospital trolley management, which is a big issue in Kerry hospital because it has been historically poor in that regard.”
“I will certainly give a copy to the Clerk. I made available copies of prepared notes last night which I expressly said I would not depend on, but they were quoted back to me. I need to reflect on how I provide information. This is a technical Bill. That is one thing. I can certainly do that. At the same time, however, this is a matter arising from what happened last night. We can manage it separately.”
“I look forward to Members' contributions and welcome the opportunity to engage in productive discussions on its provisions. I commend the Bill to the House.”
“Through the introduction of strategic direction statements and annual statements of priorities, this Bill represents an opportunity to more formally align the planning processes of the HSE with those of the Government. The introduction of corrective action proposals means a shift towards a solutions-based approach to potential overspends and allows for early intervention with the full approval of the HSE board. Importantly, this Bill also ensures that the HSE board will retain its independence and autonomy while simultaneously ensuring sufficient oversight alignment with the priorities with the Departments of Health and Children, Disability and Equality. Ultimately, the Bill represents an improvement in governance and oversight of the executive through which an improved quality of care for the nation's citizens can be achieved.”
“Either Minister, after consultation with the other, can issue a direction to the HSE to amend the proposals and can specify the manner in which they are to be amended. This direction includes a timeline for the submission of amended proposals. Sections 25 to 27, inclusive, update references to the service plan in order that it will be referred to as the performance delivery plan, as introduced under the Bill. Section 28 amends the National Cancer Registry Board (Establishment) Order 1991 by increasing the membership of the board to ten members and adjusting the quorum to account for this change. The purpose of the Bill is clear. It builds upon the foundations of the Health Act 2004 and the Health Service Executive (Governance) Act 2019 to further enhance the governance, oversight and accountability of the HSE.”
“The HSE is required to deliver services in line with the approved plan and to ensure that the expenditure incurred for the period relating to the plan does not exceed the authorised amount. Section 22 increases the deadline for submission of the HSE capital plan to the Department of Health and the Department of Children, Disability and Equality from 21 to 28 days. Section 23 introduces corrective action proposals and outlines the obligations of the HSE, the Minister for Health and the Minister for Children, Disability and Equality in the preparation, approval and implementation of these proposals. The proposals are to be developed by the CEO and approved by the HSE board. Section 24 outlines the process for amending corrective action proposals.”
“We can do that. I might speak to the Deputy about that matter again. Section 19 details the obligations of the Minister for Health, the Minister for Children, Disability and Equality, Deputy Foley, and the HSE in relation to the performance delivery plan, which will replace the service plan. The section also outlines the requirements for the preparation, timeline for submission and content and approval of the plan. Section 20 outlines the processes for amending an approved performance delivery plan. Either Minister, after consultation with the other, can issue a direction to the HSE to amend an approved plan and can specify the manner in which it is to be amended. The amended plan must adhere to the same requirements as the initially approved plan. Section 21 deals with the implementation of an approved performance delivery plan.”
“Section 18 similarly outlines the obligations of both Ministers and the HSE in relation to the annual statement of priorities for specialist community-based disability services.”
“The section requires the plan to be prepared within three months of receipt of the strategic direction statements and in a manner consistent with the priorities of the Departments of Health and Children, Disability and Equality. Section 16 corrects a reference to a provision that is repealed by the Bill. The section updates the reference to account for the new structure of section 29 of the principal Act. Section 17 outlines the obligations of the Ministers for Health and Children, Disability and Equality and the HSE in regard to the annual statement of health service priorities that will guide the executive in the preparation of the performance delivery plan. It also details the contents of the statement deadlines for issue, the amendment process and other relevant considerations.”
“Section 13 inserts a number of provisions outlining the obligations of the Minister for Health regarding the strategic direction statement in respect of health service priorities. These provisions include instructions on the content of the statement, the time of issue and the amendment process. The statement must be issued in consultation with the Minister for Children, Disability and Equality. Section 14 similarly outlines the obligations on the latter in regard to the strategic direction statement in respect of specialist community-based disability services. Section 15 outlines the new obligations of both the HSE and the Government regarding the preparation, content, submission and approval of the HSE corporate plan.”