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 am aware of that and I respect it, but I can certainly see, from my analysis of the numbers that are there and the investment that has gone in, that there is a trajectory that is moving toward reducing this in a planned way. We are nowhere near where we will want to be or any sense of removing the complete focus that needs to be there to ensure that children are getting the appropriate, timely interventions they need.”
“I do not wish to have a sense coming from this debate that nothing is happening or that nobody is getting treatment, because that is simply not the case, as Senators are aware. It is out of respect to the people working in the system that we must recognise it is, in fact, happening. We had a reduction in the waiting times for paediatric orthopaedics generally last year of approximately 15%, but it has increased in the early part of this year. I understand from speaking to the clinicians that there has been an increase in the acuity of some of the cases, which has meant that multiple surgeries or interventions have been necessary. That does have an impact on some of the times, lists and numbers.”
“If they want to speak to me privately about them, they absolutely may do so. I do not wish to read out speaking notes that Senators have heard before, but I wish to recognise that there has been considerable investment. On behalf of the people who are doing the work, I recognise the number of surgeries that have been completed and the number of interventions. I do so not on my behalf or the Government's behalf, but on behalf of the people working on this all day every day in Temple Street and Crumlin hospital. I was in Crumlin hospital yesterday and surgery was actively taking place, although, quite reasonably, I could not go to see it because people were working on it.”
“We will be transferring the very sickest children, including children with congenital heart problems who are in intensive care and children with scoliosis surgeries. We will try not to do the scoliosis surgeries immediately before. We will try to approach it as intelligently as we can, but that transfer overnight in ambulances during that seven- to ten-day period has me awake already, never mind at the time. I am very sensitive to the risk management processes for it and I am thinking about it very deeply. The important point is that I am aware of it. Senators Keogan and Duffy raised some really important, complex individual cases. Again, it is not for me, as a person who is definitely not a clinician, to be adjudicating or commenting on the individual cases, but I do hear the Senators.”
“I thank him for articulating the experience of his son and family and the difficulties that delayed treatment presents in a very real and direct way, physically, mentally and on the total humanity of every individual involved. That is why Senators have brought this legislation and are focused on thisi ssue. More specifically, however, regarding risk management and clinical migration, I am, honest to God, really concerned about all of that and how it is done. The children who will be transferred from Temple Street and Crumlin hospitals will be the very sickest children in Ireland at that time. We will have discharged everybody whom we can safely discharge in the weeks leading up to that. That is why it is important not to do it over the clinical winter. I will test that and push it as far as I can, but we will not take any risks with it.”
“We are trying all the time to bring people home who have acquired better expertise in hospitals with a larger critical mass and more specialist training and are linked to particular research universities. These are good things for the medical system. We want to try to bring those back, but if we think about the hiring process plus the giving of notice and relocation, it can take a bit of time. That is not great and I would prefer if it could be done immediately, but that is the reality of it. However, I will be working with the task force and the Department to stay on top of this. It will not be for drift, on my part anyway, that it is not done. Senator Clonan raised the risk management aspect of this.”
“I hear what Senators have said regarding the hiring standards and the higher specialist training in particular. There is the consultant applications advisory committee, CAAC, but I will check and reflect on that because we want consultants of the highest standard. It is difficult to recruit them in a timely way. CHI might have the funding for it, but to hire a specialist surgeon who is already practising in an international practice is a challenge. Let us respect that we want our specialist doctors to go abroad to get training elsewhere and to perform surgeries at a critical mass that is not necessarily available here and come back with their expertise.”
“However, I will go back, having heard the Senators, and make sure I am satisfied that all of those things are so. If I am not satisfied that they are so, I will investigate and test it. As Senators are more than aware, there was also additional funding of €5 million in 2024 to hire more posts into spinal services. We are talking about 52 full-time equivalent staff, 14 of whom are now in post, so we have some spend yet to do. There are four consultant orthopaedic surgeons, two consultant paediatric anaesthesiologists, one consultant paediatrician with a special interest in paediatric neurodisability, which is an important complementary element to it, and a number of others, including a plastic surgeon, respiratory consultant nursing posts and so on.”
“The routine cases should be higher in the broader population, and while it is best not to get into some of the reasons for that, there are very complex cases. I say that to recognise that the clinical response to these cases should be very individualised and bespoke but also very timely. Those are not contradictory ideas. The responses should be bespoke but, as Senators have said, they must also be timely. I totally agree with that. On some of the funding issues that have been raised, including the €19 million, I hear what Senators have said and I will reflect on that. Of course, I have been told the additional resources have supported the hiring of more staff at Crumlin, Temple Street and Cappagh. They have also led to a fifth theatre in Temple Street, an additional MRI scanner, 24 beds and further routine activity at Cappagh.”
“I am not clinically qualified to make those sorts of adjudications, nor do I believe, with respect, that any of the Senators here are. We will have to strike a balance between the individual cases that are raised and the complexity and humanity of them versus the clinical advice we are getting. As Senator Clonan said regarding the respect we have for clinicians and the standard we want for them, how we manage those intersections over time will be important. I will respond and try to engage with every case that is brought to me but there will be cases where, although it is difficult to hear sometimes, surgery is not appropriate, due not to delay but to comorbidities. These can be complex cases. As I understand it, many of the cases in Ireland are more complex for different reasons and there is a higher incidence of complex cases.”
“While the arrangements that have been made in respect of New York and Great Ormond Street are not what one would want in the first instance, they are very much better than not getting this done. Where they are clinically appropriate, it is better to do it than not. I would much rather invest in anything that we can do to remedy the current situation. It is not, as Senator McDowell said, the model that we want entirely, but sometimes the perfect is the enemy of the good, and it is better to use these arrangements where they are appropriate. It is also appropriate to recognise, as I understand better and better even in the short period during which I have been Minister, that not all cases are suitable for surgery, in part because of some of the complexity and the comorbidities that can present.”
“I am thinking as well about the allocation of the theatres in the new children’s hospital, the expansion of orthopaedic surgeons we have more broadly, how they will need access to theatre and the best way that we can organise that. As Senators will be aware, there is good excitement about the prospect in the children’s hospital facilities. It is a major step forward. I just want to have at the side of our mind that we might need to also go down this road. It might be a valuable thing to do to increase capacity broadly and separate out this more elective concept from the more acute concept as being a pretty reasonable clinical thing to do. Regarding the NTPF and the international arrangements, I respect the point Senator Boyhan made on the NTPF and I will consider it.”
“Particularly for parents of children, it is much easier to enable families on Saturdays than any other period. I would like to see the continuation of that approach where those cases can be triaged. It is also important to note that a number of the less acute surgeries have been moved to other facilities, Blackrock and Cappagh in particular. That capacity has been expanded, particularly in Cappagh, quite considerably. We need to conceive how we might consider the non-acute surgeries – the more routine surgeries – as an elective process within the paediatric system. We have not brought it into the elective system. We might consider how we develop the capacity in Cappagh and look at some of the capacity for more routine surgeries.”
“My perspective as Minister is to focus on making sure the capacity is there and the organisation and delivery is there, and on making sure those are the targets. Has the population been identified? Is it consistently being identified? What are the pathways to that? It was correctly pointed out that there is a necessity for triage of the different levels of severity, and I agree with that. There has been good development and it can go further in terms of how that outpatient list is being conceived and managed, including the number of Saturday clinics. I can speak to the numbers more directly on that, but there were 11 Saturday outpatient clinics last year, which quite apart from anything else is exactly how the health system should work.”
“What is the total population and what is the earliest possible opportunity for an appropriate intervention, recognising that in many cases it will not be surgery? It would not, as I understand it, be appropriate to perform surgery on a three-year-old child, for example. There is a period of growth that is necessary to allow organs to develop. A period of growth is necessary where braces, casts or minimal surgical interventions are much more appropriate than the ultimate surgery. I hope that broader public consciousness can be developed because I think the four-month thing that people have raised is sort of a distraction from the need to make sure that there is the earliest identification and the earliest appropriate intervention, and that that is maintained.”
“We are trying to do the work anyway and I would like to get to the point where it is not relevant. That is really the boarder point I am trying to make. I will address the issues in the order they were raised with me. I recognise, as Senator McDowell said, that not all patients who present need surgery. It is important for the broader public understanding that that is not so. As I understand it from speaking with medics in this space, that, say, of the 506, about 4% of the patients who present convert to surgery or are appropriate to surgery. Some 47% are discharged for different reasons. We want to identify the total population of people who are presenting with some form of spinal difficulty. I do not want to be too determinative in my language.”
“I take a similar view to the Senators. I recognise the need for legislation and, of course, we are not opposing it. I wish it had not been necessary to bring it to this point, and I would like to get to a point where this legislation is not necessary. This is a ridiculous and academic point to make but, nevertheless, I need to make it anyway. None of us here wish to make clinical decisions or judgments through legislation. That is not the purpose of the legislation, and I acknowledge that. It is important we get to the point where the system is functioning without the need for this legislation and we are not using it as an idea or as a precedent across the board to make clinical judgments. That is very much an esoteric point and not something to dwell on. It is simply a recognition that I wish it had not been necessary.”
“They met as recently as 12 March. I would have liked to attend but I was away for St. Patrick’s Day. I said to Mr. Connaughton that I would like, where possible, as long as I am not out of the country or something, to attend the next meeting of the task force, not to step on its toes or interfere with its work in any way but simply to use it as an opportunity to signal my commitment to the resolution of the issue over time, my deep interest in the area and the political support for the work it is doing. I hope that answers questions related to the task force. I would like to think we will get to the point where the task force becomes redundant and unnecessary because we will have built up both the capacity and the processes to make it redundant. That is an ambition, however, not a plan. It is an idea and an ambition.”
“Yesterday, in preparation for this, I met David Moore from CHI, who is the lead paediatric surgeon managing this. I also spoke to Mark Connaughton SC, chair of the paediatric spinal task force, yesterday evening. I will address some of the issues Senators have raised. Regarding the task force, I will clear this up now. I have no view that it should be discontinued. It is a very valuable tool that has done very good work. I respect that some of the advocacy groups have chosen not to engage with it, although the invitation remains entirely open to them. I know that officials on the patient safety side of my Department are trying to engage in different ways with some of the other advocates, who are entirely entitled to choose their own means of engagement. I respect all of that. Nevertheless, the invitation to them is there.”
“There are many different issues and I want to try to respond to everybody individually. If I do not, I will do so when I come back in on a different section because I respect and appreciate all the important points people have raised. I do not simply want to read out speaking notes or anything like that. I want to try to address the points properly. It was very important to me to be here to listen to what the Senators had to say and to respond to this legislation. I know they will appreciate that I am doing everything I can to learn as much as I can about quite a complex area. I will know more about this two months from now, for example, but I am totally committed to it and I thank the Senators for recognising that. I am evolving in my learning and understanding about the intersection of some of the aspects and the complexity of it.”
“There were 230 people waiting on trolleys over the weekend and Limerick alone contributed 79 of those. It is possible to reduce trolley numbers and the pressure in emergency departments by changing work practices alone. There was a 70% reduction nationally. This is possible without additional infrastructure but by changing work practices, in large part.”
“I just want to observe with regard to UHL that over the bank holiday weekend in February, 140 people were waiting on trolleys but this weekend there were 79. That is a 56% reduction and it should be like that all the time. There is huge capacity going into Limerick in terms of the 96-bed block and a second one. There will be 582 new beds delivered. An interim report by HIQA was brought to me and I will probably publish it today. I can tell the House now that it is basically a summary of the work that has been done to date in terms of the schedule of meetings, the stakeholders that have been involved and so on. It does not make any commitments or suggestions about the direction of travel that will be in its final report, which I expect to receive in May. We have had a 56% reduction in a number of weeks based on changed working practices.”
“I thank Deputy Murphy for his question and his focus on this issue. With regard to the specific post in question, which is a badly needed post, as the Deputy said, it is approved for filling and the process for recruitment is ongoing. One of our biggest challenges where we have funded positions is to make sure those positions are filled, and filled quickly, because patients need that, as the Deputy has highlighted again today. I will raise it again with the HSE and look for a further weekly update on the process of recruitment. However, we are in need of the staff to come into the system as well.”
“I am well aware of how much the town of Maynooth has grown in population and in its need. The best we can do is make sure that the Leixlip site is delivered and services are available there, that services in Maynooth are also delivered to the extent possible and that the broader community has access to both centres. I thank the Deputy for his question. There is no lack of commitment in relation to Maynooth, just this direct problem which I hope we do not continue to have. We will have to figure out a way around it, otherwise we will not get anything built.”
“I am not trying criticise planners or their decisions - I appreciate that every application is different - but there was a need for a site in Maynooth, planning permission was applied for to turn a health centre into a health centre and now we have to do it in Leixlip.”
“I could not agree with the Deputy more. The intention was to do this in Maynooth. Several site locations for the Maynooth area have been explored since 2015 within HSE and State capital, but with no success. The important point is that the HSE applied for planning permission to develop a primary care centre on the site of the current health centre in Maynooth and it was not approved. The HSE had to seek planning permission to turn a health centre into a health centre, and it was not approved. I have a serious commitment to developing health infrastructure in this country. I want to deliver the services that I believe Maynooth and everywhere else needs. I am serious about the infrastructure guidelines and how we have to go about doing things. It will hamper the delivery.”
“I examined the location, distance and public transport routes between Maynooth and Leixlip to best understand how people would access the more significant service that will be available in Leixlip. I am aware that Maynooth continues to grow. It was the original intention to have that facility there. A number of issues have been thrown up in that infrastructure process that give me pause as Minister for Health as to how we will deliver better infrastructure around the country.”
“The development of the larger primary care centre in Leixlip has some advantages for service users which include access to a larger multidisciplinary team and the co-location of both core services and the enhanced community care programme community specialist teams in a larger and improved clinical space. It is welcome news that we are moving forward with more services in that region generally. A schedule of accommodation is being finalised with a view to the HSE tendering in the second quarter of 2025. I recognise that the population is growing in Leixlip and Maynooth. I welcome the HSE's commitment to continuously review infrastructure in those areas in conjunction with Kildare County Council.”
“I thank the Deputy for allowing me to update the House on this matter. Significant consideration has been given to developing primary care centres for both Maynooth and Leixlip. Since 2015, while several site locations for a primary care centre in Maynooth were explored, no suitable option has come about. As a result, a larger primary care centre will be built in Leixlip to serve both the Maynooth and Leixlip populations and their surrounding areas. However, and importantly, as part of that plan, the HSE will continue to deliver health services locally from the Maynooth health centre which will serve as a satellite and complementary unit to the larger north-east Kildare primary care centre in Leixlip.”
“These are readily available to be done and I encourage everybody to try to spread this word, especially when it is women's health week. I thank the Deputy for her focus on women's health during this week.”
“I launched three such research programmes identifying exactly that aspect, as well as identifying women who may experience particular risk factors through gestational diabetes or experiences during pregnancy or maternity generally that may be markers for cardiovascular difficulty in future. I also wish to highlight to everybody quite how easy it is to have an early marker check. Yesterday, I went through the horrid situation of having my blood taken and checked, which I despise. Nevertheless, it is a very useful process. I got the results 20 minutes later, which, notwithstanding some stress, were absolutely fine. The point is that they could just as easily have shown an early marker. Would we not much rather find out about an early marker for risk for the future?”
“I am committed to women's health action right across the country, but these are some specific examples. This is additional to women and girls in County Louth being the beneficiaries of the broader supports in relation to HRT yet to come and the cost of contraception supports.”
“Water birth services commenced in late 2023. Postnatal services are to be further developed in 2025. Of course, it was one of the first hospitals to implement termination of pregnancy services. It has also had an ambulatory gynaecology clinic operational since late 2022. Within the Louth-Meath CAMHS service, two new advanced nurse practitioner posts have been approved specifically for eating disorders. This is a particular problem for young girls especially, as the Deputy has identified. Funding has supported the provision of free period products in buildings and facilities managed by Louth County Council. BreastCheck is also currently operating a mobile breast screening unit in Drogheda. There are 56 cervical screening contract holders in primary care in County Louth.”
“Not only that, but when women do express symptoms, they have often not been listened to. That was particularly evident to me in the new funding we have given from the women's health fund to cardiovascular care in particular yesterday, where there was an acknowledgment of bias in understanding symptoms and the way in which women describe them. The implementation is ongoing for the second women's health action plan for 2024-25. Our goal is to improve health outcomes and experiences for women and girls nationwide, and that has been supported by additional investment of over €180 million. Specifically, as regards County Louth, significant investment has been provided to Our Lady of Lourdes, Drogheda, for its maternity and gynaecology services, including the midwifery-led unit operational, with services extending to the community.”
“We are trying to reach different groups in the broadest possible way and reduce the cost of medicine and access to medicine. In addition, all children under the age of eight years and all people aged 70 and over are now automatically eligible for a GP visit card. On the basis that most of our primary care is attempted to be delivered through the GP and primary care network closest to home and getting the original access, it is a really important step. I encourage every Deputy to encourage their constituents to check if they are eligible.”
“Again, yes, it is about getting a balance, and we want to extend eligibility and reduce costs as much as possible. The very last thing that I or anybody else in this House wants is somebody not getting medical care because of a question of cost. The Government has taken a range of different ways to spread the benefit it is giving to people in the broadest possible way in addition to medical cards. The GP visit card is one. I would love to see 430,000 people taking it up and using it when they need to use it, supplemented by the drugs payment scheme, supplemented by the long-term illness scheme, which I think needs review as well, supplemented by removing the public inpatient charges for children and adults, and supplemented by our extension of contraception.”
“As a result of that initially slow update, a media campaign was rolled out to encourage uptake in 2024, including radio ads, out-of-home ads and in-office screens. The other 400,000 people who are eligible for a free GP card might look at the income limits and see if they are eligible.”
“Of course, every extension of eligibility means that we cannot do something else, and we have to try to get the balance right. In 2023, GP visit card eligibility was extended enormously. While that does not meet everything, if you have a GP visit card plus the drugs payment scheme plus, potentially, the long-term illness scheme, there are a lot of measures that the State is taking towards reducing your costs in different ways, and the combined effect is very significant. What I really struggle with is that while 430,000 people were estimated to be eligible under that expansion, as of 13 January this year only 38,517 GP visit cards have been awarded under that median income expansion. It is not as though we do not want people to take them up.”
“People aged 70 or older are assessed under medical card income thresholds which are based on gross income. However, those aged over 70 can also be assessed under the general means-tested scheme where there are particularly high costs. I assure the Deputy that my Department keeps medical card issues under review in order to ensure the medical card system is responsive and sensitive to people's needs. Over the course of 2025, we will review the existing eligibility framework to clearly assess what is working well and to inform future policy proposals regarding the eligibility framework based on robust evidence. That is an important step towards delivering universal healthcare in Ireland.”
“I thank the Deputy, and I look forward to working with him as we worked together on the public accounts committee. Eligibility for a medical card is primarily based on a financial assessment, as the Deputy is aware, which is conducted by the HSE in accordance with the Health Act 1970. The HSE assesses each medical card application on a qualifying financial threshold. That is the amount of money that an individual can earn per week and still qualify for a card. It is specific to one's individual financial circumstances. People under 70 are assessed under the general means-tested medical card thresholds which are based on an applicant's household income after deduction of tax, PRSI and universal social charge. Certain expenses are also taken into account.”
“It is always important as well to recognise the debilitating impact that endometriosis can have on somebody's life, their ability to be at work or their ability to care for children. It is a serious condition that needs intervention. It is important to set out where the specialist centres are. There are supraregional ones in Dublin, in Tallaght and in Cork University Maternity Hospital. The five regional hubs are in the Rotunda, the Coombe, the National Maternity Hospital, University Hospital Limerick and University Hospital Galway. The idea is to try to provide interdisciplinary care to women experiencing endometriosis up to a moderate stage - for example, the cohort of women whose symptoms cannot be adequately managed in their primary care setting.”
“It is a good thing to note that 1,150 new patients were seen across those sites in 2024, though I imagine there are more in need. Personally, I am committed, as I know this House is, to fully implementing the Women's Health Action Plan 2024-2025 to continue to improve women's health outcomes and experiences.”
“The development of a national endometriosis framework was announced in 2023 and the HSE has advised that framework is nearing completion. I know that women with endometriosis have a keep interest in seeing that framework, as they rightly should. The HSE is engaging with all stakeholders in its attempt to finalise the framework. The clinical pathway for endometriosis care spans primary, local and specialist hospital care. Not everybody needs specialist hospital care but for those who do, they absolutely need it. The model of care ensures treatment through supraregional specialist centres with a support network of five regional endometriosis hubs. The HSE has advised these sites are currently taking referrals and providing treatment pathways. The supraregional sites offer specialised care to more complex cases.”
“I thank the Deputy for raising this important issue, which has been a hidden difficulty for many women for many years. It is great to see it mentioned so freely in the Seanad yesterday and in the Dáil today. I thank her for raising it. It is estimated that one in ten women will be affected by endometriosis and although not all women will be symptomatic and not all women will experience it in the same way, it can be really debilitating for some women and our health service should support those women in every way possible. Treatment for endometriosis ranges from everyday pain medication and hormone treatments to surgical interventions. Budget 2024 provided an allocation with a full year cost of €2.175 million for 2025, which brings the total investment for endometriosis care to more than €5 million since 2021.”
“We also have the NAS off-duty responder scheme, where we have 682 National Ambulance Service staff involved. Pending the results of the review, the National Ambulance Service took it upon itself to inform people there may be a benefit-in-kind liability. Had it not done that, it would have been rightly criticised for being aware there may be a liability that would accrue to people and not having informed them. We await a ruling of the Revenue Commissioners on it.”
“I do not disagree with the Deputy one bit about the value of the service they are providing. The National Ambulance Service prudently is seeking a ruling on whether there is a benefit-in-kind liability and has informed people there may be a liability to put them on notice of that. We await a determination. The review is useful more broadly because it will look at the scale of use of response vehicles for out-of-hours, as I said, but it will also determine the benefit and balance of the use of those vehicles out of hours compared to others existing out-of-hours or voluntary responses including, as we all know, the community first responder schemes. We have 300 of those schemes and 4,000 community first responder volunteers nationwide, which is extraordinary.”
“The NAS has sought such a ruling and the review of the scale of the use of response vehicles for out-of-hours incidents is being examined. The results of that review will be presented to the HSE in April 2025. I agree about the good work done but it has to comply with the rules as well.”
“I thank the Deputy and of course, I clarify for the benefit of others watching and not for him in respect of the patient-carrying vehicle. I know that he knows this but perhaps others have not been as involved in this issue as his good self. This review was prompted by the National Ambulance Service itself. It undertook a review in September 2024 of the procedures governing the out of hours use of official response vehicles. It identified a potential benefit-in-kind liability. It is much better and more prudent to have taken that approach rather than to find out after the fact that it had been done wrongly and a liability had accrued. It is a precautionary measure and it has sought a ruling from the Revenue Commissioners. We all have to comply with the rulings of the Revenue Commissioners.”
“That includes €8 million new service development funding, with a full year investment of €16 million in 2026, to deliver up to 180 additional posts this year.”
“It is important to clarify that the response vehicles highlighted by the Deputy are not patient-carrying vehicles and that is a really important distinction. The vehicles in question are rapid response vehicles for authorised NAS staff to respond to an incident in support of an emergency ambulance while on duty but they are not patient-carrying ambulances or patient-carrying vehicles. The decision taken by the National Ambulance Service, pending the ruling by the Revenue Commissioners that has been sought, does not impact on the National Ambulance Service emergency ambulance provision. I emphasise the Government's commitment to investing in our National Ambulance Service, with an allocation of €285 million in 2025.”