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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“The model of care we are talking about is intended to be based on a consultation - putting people at the centre - with stakeholders, healthcare professionals and crucially those who use and receive support from the services and their families.”
“I agree with the Deputy and the person-centred approach is what we want to get to. Everyone is entitled to healthcare. I agree completely with him on the points he raised and I hear his important perspective on the national gender service. It is important that it be articulated here this evening and I hear him clearly on it. I do not want to get distracted by the WHO definition, which is slightly more technical and does not sit against what we are speaking about in any way. It is not a clinical guideline. It is a classification system. I can give the Deputy more information on that by way of background if it is of assistance. It will not cross over the sort of model of care I want to get to, which sounds like what he is describing. There is no reason to be at cross-purposes on it. Perhaps we can speak about it in more detail.”
“What absolutely is the case is that a multidisciplinary approach, including endocrinology, psychology, appropriate counselling, psychiatry if and as needed and the support of social workers if required, offers the best pathway of support and that is certainly the approach I hope the model of care will lead towards.”
“I fully hear what the Deputy is saying. His feedback is important to me, as is everyone's. I did not congratulate him on his new position as Chair of the Oireachtas Committee on Health. I look forward to working with him on this and many other issues. We have a similar approach to these issues. It is important to recognise that demand for transgender healthcare services has increased and I acknowledge that the current public services are not meeting people's full range of needs. For that reason, the HSE is developing the new model of care for gender healthcare services. The Deputy is right to identify that it is not a mental health condition. Of course, it is not.”
“It is important to note that the ICD-11 is not clinical guidance for gender healthcare. It is a system of classification where criteria for various diagnoses are described. From our perspective, we want a holistic, compassionate, respectful service at every stage of a young person's or adult's journey, at every point of contact. That is the approach I will take as will everyone in the Department of Health, including all the Ministers of State, to this issue and I know it is the approach of this House.”
“The model of care will be developed in a consultative way, engaging with healthcare professionals in gender healthcare, stakeholders, including people with lived and living experience and the families of people who use and receive support from services. It is important that the HSE is given time to develop a model of care that is based on the best clinical evidence and that will deliver the best outcomes for people with gender dysphoria based on respect, compassion and understanding. As the Deputy may be aware, the WHO’s international classification was updated to its current version, ICD-11, in 2019 and gender identity-related health diagnoses were moved from the chapter on mental and behavioural disorders into the new chapter on conditions related to sexual health.”
“The programme for Government commits to ensuring a transgender healthcare service that is based on clinical evidence, respect, inclusiveness and compassion. A new model of care is currently under development to strengthen and standardise care, ensuring safety and best practice. My Department provided €770,000 in budget 2025 to support this. The clinical lead has been appointed, a cross speciality clinical advisory group has been established and a review of the evidence base is under way. A community pilot project to identify the needs of children and young people who are gender questioning will also commence in the coming months.”
“-----because the roles of the Departments are equally important in how we take this forward and they must be clearly working together on it. This would be an important piece of work for the committee and I look forward to working with it on it.”
“I agree and accept that. The health (adult safeguarding) Bill is in the current legislative programme, but the policy must be considerably settled and developed on a cross-departmental basis. This is as much a question for the committees on disability and children as for the Joint Committee on Health-----”
“It is a newly created position and a person was appointed last year. It is a significant appointment. Similar to the chief nursing officer, these are important cultural signs about the importance of those roles and the functions they carry out. However, I agree with the Deputy in respect of legislation.”
“I agree with the Deputy. I also want to reflect the work of the Law Reform Commission report in this regard. I hear what the Deputy is saying with regard to policy. Of course, the policy analysis is to bring us to the legislative path, because that has to be agreed across the different Departments with regard to that. It is also important to note, though I know the Deputy is already aware, that while legislation is important, it is everybody's business to do this correctly in the meantime. It is everybody's responsibility. Driving a proactive and open culture of safeguarding is also a key focus of the policy, though I accept what the Deputy has said with regard to legislation. It is important to consider and acknowledge the role of the newly appointed chief social worker in the HSE.”
“There is a pressing need for robust safeguarding frameworks. That was thrown into sharp focus for all of us again with the recent publication of the Farrelly commission’s report on the Grace case. I am mindful too of other safeguarding failures that we must work hard to ensure never happen again, including the recent Brandon and Emily cases. I assure the Deputy that this is a priority for me. I expect to see progress within my Department and on a cross-departmental basis this year. I expect to be able to update the Deputy in that way.”
“My Department is at an advanced stage of finalising a national policy on adult safeguarding for the sector, in liaison with the Department of Children, Disability and Equality. This will be the first national policy in this area and is a significant development. Considerable work has already been undertaken to inform this policy, including an international evidence review, stakeholder engagement and a public consultation last year, which received more than 250 responses. I hope to bring this policy to the Government in the coming months. Second, the Government has included a health (adult safeguarding) Bill in its current legislation programme. This will facilitate underpinning legislation for this sectoral policy. Drafting of this legislation will commence once the policy is finalised.”
“I thank the Deputy for his ongoing work on this. Safeguarding adults who may be at risk of abuse is a very important objective for me, my Department and all health and social care services. A framework of standards, policies and procedures for safeguarding adults in the health and social care sector is already in place. This includes a national safeguarding office in the HSE, specialist safeguarding and protection teams in each health region, designated safeguarding officers within services and specific regulatory requirements for residential care services which are inspected by HIQA and the Mental Health Commission. Further measures are now being developed to strengthen that framework.”
“I would have thought that everybody in this House on the side of the women of Ireland would be behind that and working through the other issues that are also there. I engaged strongly with the IPU at its conference and since its conference. I thanked it for its continued engagement. I hope we will find a way through on all of these issues, but I have learned a lot about the Labour Party's position this evening.”
“The €5 is the top fee that is paid under the current structure. The €6.50 is the once-off fee for contraception. I gave pharmacists the option to charge above €6.50 - €7, €8, €9 or €10, whatever they wanted - and they refused that. It is a very interesting position for the Deputy to have adopted this evening. I am trying to give every option possible to deliver for the women of Ireland, but I am hearing IPU speaking notes back, which is an interesting position for the Labour Party to take. What is the cost of setting the fee at €6.50 for the rest of the schemes that we have? We can tease this through over the coming days, but I strongly suggest and hope that pharmacists will sign up. The best option for the women of Ireland is a €5 dispensing fee to be paid to pharmacists because it makes it completely free for women.”
“I have correspondence that says there are no IT issues, and we should watch that progress over the coming days and weeks. I acknowledge the lack of HRT. There is an issue of medicine shortages across Europe, as we have discussed before. That is precisely why I have tried to recognise the experience and expertise of pharmacists to make sure they are recognised for what they do. I am not exactly sure what the Deputy would have me do differently. I made them two offers: one was an uplift of 20% and the other was an offer to charge anything they liked. I am not sure what the Labour Party position would have me do on behalf of the women of Ireland in order to get this effected, but perhaps the Deputy might advise me.”
“The first thing is that I issued a press release in relation to this and then went on a media outlet. I must check when the Deputy last went on a media outlet and whether she regards that as an effective way of communicating either her party's position or to her constituents in any way. It is certainly a way for the Government to communicate, as we often do. The fact that we go on a different show means what, exactly, aside from being a way of communicating directly and taking questions, having issued a press release and having engaged? There is no question of power in this regard; it is a question of delivering for women. I suggest, very carefully, that the Deputy goes back and discusses the IT system issues with whoever has briefed her regarding it.”
“It is essentially a 15% to 20% increase on the existing dispensing fee for those products under the GMS and DPS at present. I made that in order that it would be an uplift for all of the women who are on the GMS or DPS. It would be a 15% to 20% uplift on the average dispensing fee paid in that case. Of course it would be €5 for all of those private patients who are paying at the moment. I made that offer to every pharmacy by writing directly to them. I also spoke at the IPU conference last Saturday.”
“I have prioritised substantial engagement with the Irish Pharmacy Union to find a pathway forward on the issue. I listened to its position - and this is important - that its members did not want to see the cost of medicine and the dispensing fee decoupled under a State-funded arrangement. Nevertheless, the Deputy will be aware that I did of course give them that option to charge the fee they are currently charging. In the spirit of compromise I offered to invest healthcare funding on dispensing fees, which was not intended from a healthcare budget perspective and not intended as Government policy in this space. I offered every participating pharmacy a €5 dispensing fee for each and every HRT product. The €5 fee is the highest fee paid under the community drug scheme to date.”
“I thank the Deputy for the question; it is an important one. I thank colleagues for their support on the approach taken to date. I want to be absolutely clear in relation to the intention with regard to the HRT initiative. Budget 2025 aimed to continue the good work ongoing to improve women's healthcare, and in particular to support women on their menopause journey. It was originally intended the State would pay for the HRT product - for the medicine - and pharmacies would be free to continue to charge a professional service fee to women who are not eligible either for the GMS or the drug payment scheme, DPS, while recognising there are many women who are getting this for free already. The programme for Government then re-emphasised the scope of that commitment.”
“It is really important that CHI confirms the number of letters it has sent. It is not just CHI, it is also Cappagh hospital. They are two different numbers. I expect CHI to provide that and that the HSE would have provided that by now. I expect this information to be clear but I do expect it will continue to evolve. The most important thing is that we get the report, which will stand us all in much better stead on the next steps we must appropriately take.”
“We are making the same case with regard to CHI and spinal surgeries. I am simply making the point that surgeons have to respond to the investment that this Government and this House has put into the services. I expect them to do that. On CHI and the hip dysplasia, it is a matter for CHI to give that number and to be able to confirm that. I will use every power I have to make sure they do that. I will request they publish that number and there is no reason not to. By way of caveat, I do understand that the reason for the numbers going back to 2010, which I gave to the Deputy in reply to a parliamentary question, is that any follow-up requirement relates to skeletal maturity, which is typically around 15 years of age. This is a clinically based decision as opposed to any other set of criteria.”
“To be clear, the Government has provided significant additional funding, which has resourced an uplift in staffing and provided additional infrastructure. If Deputies opposite were saying there was no theatre or there was no ring-fenced bed or there was no increased access to MRI or there was no additional surgeons or provision for it or if they were saying there was no investment enabling national and international outsourcing to three additional sites in Ireland, as well as two hospitals abroad in the UK and the US, I would accept all of those things but all of those things have been done and there is no excuse for not getting on with dealing with the cases that need to be dealt with.”
“I will respond to the second part of the Deputy's question. In respect of both reports the Deputy and I await, which are very important reports that everybody is entitled to see, I am given to understand by CHI that it expects to receive them very shortly and in the next number of weeks. I feel as though I have said that before, however, and I really do expect to receive them. As I have said to the House previously, it is not directly within my control but I do expect to receive those very shortly. On the broader question of addressing the lists and the times, as we discussed previously, the more referrals and more outpatient clinics there are, the more people will be added to the waiting list. That is okay. What is not okay is the duration of time they are waiting.”
“I have asked for a revised plan to be submitted without further delay that effectively addresses the waiting list, obviously with the focus on the longest waiters and recognising the various levers that have been provided to the Government.”
“However, as I have told the House before, what matters is the Sláintecare targets. We must not let the numbers distract from the reality. Progress on the part of CHI and the people in charge of delivering these surgeries has been too slow. Too many children are still waiting. The operational plan I received for spinal services did not propose a significant level of activity to meaningfully address the waiting lists or a level of activity that is commensurate with the level of investment that has been put in. When I met the CHI board on 14 and 28 April, I made it clear that addressing these waiting lists is a top priority and that we need a new and much more ambitious plan.”
“GPs can now access a clear referral pathway to prioritise urgent cases. Additional outpatient clinics have seen more than 600 new patients, which has reduced the waiting list for initial assessment by 40% year on year. We need to maximise capacity. Surgeons have been given the pathways to do so through national and international outsourcing. These initiatives are driving some progress. In 2023, 513 spinal surgeries were completed, which represents a 35% increase on 2019. The initiatives are delivering results for many children and families, although I accept not for all. The number of children waiting longer than four months dropped by 37% last year. At the end of April, 68 children remained on active spinal waiting lists for longer than four months. This is an 18% reduction compared with last year.”
“I thank the Deputy. I will update the House that I have now met all of the advocacy groups representing the children, young people and families affected by spinal conditions. I thank them sincerely for their time and their honesty. I have heard directly from them about the impact that gaps in communication and long waiting times can and do have on children and families and I have assured them of my commitment and the commitment of this Government to improving paediatric spinal services. By way of background, the House will be aware that more than €30 million has been allocated to reduce waiting lists in this area over recent years. Targeted initiatives have been making some difference in how we deliver spinal services. It is important to point out that CHI has a ring-fenced theatre providing dedicated capacity.”
“To give the Deputy comfort, I would point out that Limerick is the only hospital that is consistently providing the correct rostering over the weekends and has very significant increases in its discharges as a consequence. However, it is stuck on capacity in terms of beds in particular, and the 96-bed block is absolutely crucial. I expect that to be delivered in September.”
“I have been told to expect that report from HIQA in May. I have no further details beyond that. We always debate matters in the Dáil, so there is no difficulty with that. I would point out two things. The Deputy is right about Limerick. It is under particular pressure. The opening of the 96-bed block is absolutely essential to alleviate that pressure. Other than that, there are sites of considerable concern that cannot be explained in the same way. I want to call out St. Vincent’s hospital in particular as well as Tallaght, Cork and Galway. I mention St. Vincent’s in particular. I am doing a detailed analysis of the rostering in these hospitals.”
“I am conscious that the Minister of State, Deputy Murnane O’Connor, has responsibility for this. I might ask her to come back to the Deputy directly on the details on this. I know she is very interested in this and has a very strong focus on consultation. I might ask her to come back to the Deputy with her ideas.”
“The Government commits to opening surgical hubs and assessing the business case for a surgical hub in the north west. The HSE is developing that and I have yet to receive it. The factors the HSE will take into account include the population distribution. I had a very good visit to Letterkenny hospital last week and note its funding has increased by over 54% in recent years. The staff number has increased by a quarter and there has been a very significant investment, but it is also true that the surgeons in the hospital need more surgical capacity and, in particular, more beds to ensure they have scheduled surgical access. I am very well aware of that.”
“I ask Deputies to allow me to come back to them once I have received the report and had the opportunity to understand what it means and what it looks like. I am very happy, for example, to immediately meet the health spokespeople and work through how we might best address that. I know they have been contacted by many people, as I have. I know that those people are worried and do not know whether they were included in the audit or were outside the period. I know that they do not know what has happened or how best to address it. However, I am here to try to do that with the Deputies and I ask them to do it with me. It would be so wrong of me to come in here and speak about a report I have not received. I think the Members opposite would rightly criticise me for that.”
“I am told the audit process is at an advanced stage. Feedback on the draft report has been received by the expert who is authoring it and that is being reviewed. In the meantime - and this is important - as a patient safety precaution, as I know some Deputies are aware, a single cross-site pre-operative decision-making process for any planned DDH surgery in CHI and in Cappagh has been implemented. All the cases are being reviewed before any decision for surgery is made by clinicians from CHI Crumlin, Temple Street and Cappagh. That MDT process, that multidisciplinary process, commenced in the first week of March 2025. An action plan is being drafted, and that plan includes the identification of groups of patients who may not in fact be included in the audit samples but who may be impacted.”
“As a response to that, letters were sent to parents whose families were in this process where surgeries had occurred. The clinical audit was to assess whether the indications and threshold used to select patients with DDH for pelvic procedures were in keeping with international standards of practice over a three-year period between 2021 and 2023. The clinical audit was completed on a random and anonymised sample of patients aged one to seven years who had those procedures from 2021 to 2023 in both CHI and Cappagh hospitals. The purpose of the audit, and this is really important, is to assess whether the indications and threshold used to select patients were in keeping with international standards. Let us see what that report says. The audit process is now in the final stages and, as I said, it will be published.”
“Obviously, the best way for this to happen would be that the audit would be received, people would be contacted, there would be a natural sequence to these things and that it would be appropriate because I agree that families receiving letters in the post saying they might be impacted by something is just so worrying. When you go to get your post, you get your bills and something from Revenue but to get a letter like that about a surgery that your child had five or six years ago is so worrying. Those letters were sent in response to the fact that this issue came into the public domain - and I always respect the work of journalists, of course - prematurely, or earlier than I could control because the report has been completed or given to me.”
“I will 100% debate this report with the Deputies once I receive it but I have not received it. It is not as though it is in my handbag, nor is the Nayagam report. I have not received them but when I receive them, in the same way as the HIQA report, we must debate these things. We will debate them again. We will also debate the different structural and recruitment challenges and all of the different challenges we all face together in trying to improve these different services which I, as Minister, am very clearly responsible for. I recognise that the sequence of this is not where one would want it to be. We have a clinical audit and the clinical audit was public since last June or July. Of course, it is necessarily selective and anonymised because it is a clinical audit.”
“As Deputy Brennan expressed here this evening, to have a situation of being given a diagnosis, and Deputies described in letters that have come in to them, that was a wrong diagnosis, a treatment option that was incorrect, a treatment option that was unnecessary or a treatment option that was excessive on the bodies of small children for any reason, nobody here could possibly stand over it. It is so important that we get the correct information from this audit, reflect on the report that has been completed and make our next decisions together about what is next and what is appropriate. All of this is driven by genuine horror from us all, epitomised by Deputy Brennan's contribution of this own personal experience of this and we absolutely share this.”
“I support other Deputies when they said it was a very significant contribution. I will not forget it and I do not think anybody here will forget it but it speaks to the complete humanity of the experience of families impacted in this way, the complete humanity of the decisions given to families or the complete humanity that is caught up in the diagnoses and treatment options. I have a child who had an emergency surgery in Crumlin that was completely appropriate and done on a Sunday morning at 10 o'clock, having been diagnosed at 7 o'clock. It was completely appropriate. In the previous debate, we talked about three categories and this was the correct response.”
“This is a debate we should have but I would like to have it when the report is complete and published. I would welcome that opportunity again. As I said, I will insist on the report being published in full, save for the personal details. I am also very conscious that it is an audit in respect of a portion of time. I am very aware that it may be important to do something further but again I would like to reserve my own judgment on that until I have had the opportunity to see the report. I hope that is a fair reflection of the procedural element we are looking at this evening. We have had a number of hours of debate on these very important issues, which I welcome. By far, the most important contribution to this issue over many years has been that of my Fine Gael colleague, Deputy Brian Brennan.”
“They may be and we will see that when the report is published but it is possible they are not or there are other things going on. Given the seriousness of the issues, which everybody would agree with, I need to be careful that we handle that in an appropriate way going forward. I am very happy to have this debate based on the report when it is published because it is so serious and so important. I have to move an amendment to the motion because it contains details I cannot stand over factually. I do not want to do that but I do not have any alternative to that. That is a procedural point but, for example, were it to be the case that Deputies said the Government voted against their important motion on spinal issues, that would not be correct. It would not be procedurally or ethically correct.”
“That has not finished and therefore it is not finished. It has not been given to me. I cannot publish it. I have committed to publishing it. On the remarks of the previous Deputy alluding to a silence or a cover-up, it is factually wrong, and I have to say that. However, I wish we could just debate the issues and that will be better enabled when the report is published. I am very happy to do that when the report is published. As the report is not published, the motion is constructed based on reports in a media outlet that I cannot verify or stand over and that may be correct or may not be correct. Nobody on that side of the House knows the answer to that either. They do not know whether the facts they have asserted in this House are accurate.”
“— plans are also being put in place for patient follow-up as required in line with good practice and will consider any recommendations with regard to clinical follow up from the final report; and — a communications plan is also being developed to support the publication of the final report and further communications to patients and families.". I welcome the opportunity to address in this House the issues raised by the Deputies tabling the motion. However, I wish we could have this debate following the publication of the report. The reason the report has not been published is that it has not been finished and it has not been given to me. It is not a question of Government acting in silence. There is a clinical audit being done and it has not been completed. There is due process involved with its completion.”
“I move amendment No. 1: To delete all words after "Dáil Éireann" and substitute the following: "recognises that: — Children's Health Ireland (CHI) was made aware through the protected disclosure process of a concern relating to the threshold criteria being used for surgical intervention in relation to development dysplasia of the hip (DDH) September 2023; — the concern related to different indications for DDH surgery between CHI Temple Street, the National Orthopaedic Hospital Cappagh (NOHC) and CHI Crumlin, with a lower threshold for surgery at Temple Street and NOHC for children, this resulted in different practices across the sites in CHI and NOHC; — the Department of Health was notified by the Health Services Executive on 9th May, 2024 that a clinical audit was to be conducted in CHI and the NOHC; — the clinical audit is being conducted by an external international expert on surgery for children with developmental dysplasia of the hip performed during the 2021-2023 period across CHI and the NOHC; — the Minister for Health is awaiting the final report of the audit, which is expected in the coming weeks, before any conclusions can be drawn on this matter, further details will be shared once the process concludes, respecting confidentiality and due process; — patients and their families will have understandable concerns, and CHI and NOHC have issued letters to families to provide reassurance and information about the audit pending its completion; — as a patient safety precaution, a single cross-site pre-operative decision-making process for any planned DDH surgery in CHI and NOHC has been implemented, all cases are being reviewed before any decision for surgery is made by clinicians from CHI Crumlin, Temple Street and NOHC; — an action plan is currently being drafted, this plan includes identification of groups of patients not included in the audit sample but who may be affected by any findings of the audit.”
“Regardless of who stands here - it could be any of us - we are going to have the same difficulties in terms of recruitment and the availability of surgical staff, doctors and nurses. We have 52 funded posts, 22 of which are in situ . Interviews are progressing. I will do everything I can to advance and expedite recruitment but I am under the same constraints as any other person would be. We need to work together on it and have a clear recruitment plan and funding in place. We are trying to recruit and attract from different places. Certainly, the interviews and the wider recruitment process goes on. I am conscious that I am out of time and that we are now about to speak about something very similar. Perhaps I can address this further then.”
“Four additional orthopaedic consultants are being recruited, one of whom is expected to begin during the summer but none of whom is in post. If I spoke incorrectly, and I feel that I did, I wish to be very clear in that regard. Regarding the publication of the DDH report - we will come back to this in the next debate - I have some concerns about how a couple of Deputies said that people only found out through media reports. The fact of the audit has been public since June or July 2024. That is an important clarification. On workforce planning and staffing of all areas, not just paediatrics and spinal surgeries, but the hospital more broadly, there is engagement with unions and there is engagement between the HSE and CHI to agree that workforce plan.”
“-----or oversight that it might otherwise have. For example, of the 12 members, four are nominated by the Minister, four are nominated by the board itself and approved by the Minister and the chairperson is chosen by the members of the board. Therefore, it is a bit different. My concern is that, whatever happens 16 or 18 months from now, we have a functional governance structure that enables us to do those two most important things. However, I hear what the Deputies have said to me about their perspectives on this over time. What I am trying to manage is the governance over the other issues. One concern I have is that I said something incorrectly. Forgive me if I did. To be clear regarding the number of orthopaedic consultants and posts we have, there are nine consultants in post.”
“As I said at the outset, there are two things we need to do much better over the coming 12, 14, 16 or 18 months. The first is to open the hospital. The second is, obviously, to ensure that we have the improvements in spinal surgeries that we all want to achieve. The legal structure is under the 2018 Act, where the board is constructed, created and managed differently to any board I have ever seen before, in the sense that it does not have the same direct ministerial - I do not want to use the word "control" - direction-----”
“It is an initial audit that covers a certain period - I am aware that there are other cases, and we will discuss them - but I have not received it. I know we will discuss it in greater detail. The Nayagam report was commissioned on behalf of the HSE CEO specifically because he was not comfortable enough with the internal CHI response. Deputies have correctly asked me about the implementation of the rest of the recommendations. I am given to understand that the end of quarter 2 - June - is when the remaining recommendations will be complete, but I will update the Deputies. I have also been asked a number of times about the CHI board, the governance structures and moving into the next hospital. They are the same questions that I would ask and have asked.”