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 Header Item Written Answers Nos. 114 - 133
 Header Item Home Help Service Provision
 Header Item HSE Properties
 Header Item Medicinal Products Licensing
 Header Item Food Labelling
 Header Item Health Promotion Issues
 Header Item Infectious Diseases Incidence
 Header Item Substance Misuse
 Header Item Dental Services Provision
 Header Item Services for People with Disabilities
 Header Item Domestic Violence Incidence
 Header Item General Medical Services Scheme Administration
 Header Item Hospital Waiting Lists
 Header Item HSE Properties
 Header Item Primary Care Centres Provision
 Header Item Dental Services Provision
 Header Item Medical Card Applications
 Header Item Medical Aids and Appliances Applications
 Header Item Health Services Provision
 Header Item Hospital Staff Issues

Wednesday, 5 December 2012

Dáil Éireann Debate
Vol. 785 No. 2

First Page Previous Page Page of 72 Next Page Last Page

Written Answers Nos. 114 - 133

Home Help Service Provision

 114. Deputy Patrick O'Donovan Information on Patrick O'Donovan Zoom on Patrick O'Donovan asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the number of persons currently in receipt of private home care hours; the cost to the State for the provision for this service; and if he will make a statement on the matter. [54678/12]

Minister of State at the Department of Health (Deputy Kathleen Lynch): Information on Kathleen Lynch Zoom on Kathleen Lynch As this is a service matter it has been referred to the Health Service Executive for direct reply.

HSE Properties

 115. Deputy Brian Stanley Information on Brian Stanley Zoom on Brian Stanley asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the amount the Health Service Executive spent annually for 2009, 2010 and 2011 on renting residential accommodation in the counties Laois and Offaly. [54683/12]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly Management of the health property estate is a service matter. Therefore your question has been referred to the Health Service Executive for direct reply.

Medicinal Products Licensing

 116. Deputy Terence Flanagan Information on Terence Flanagan Zoom on Terence Flanagan asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if he will respond to a query regarding generic substitutions for medication (details supplied); and if he will make a statement on the matter. [54686/12]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White Under the Health (Pricing and Supply of Medical Goods) Bill, the Irish Medicines Board has statutory responsibility for establishing and publishing a List of Interchangeable Medicinal Products. In deciding whether to add a group of medicinal products to the List of Interchangeable Medicinal Products, the Board must be satisfied that each medicinal product which falls within the group:

(a) has the same qualitative and quantitative composition in each of its active substances as each of the other medicinal products which fall within the group;

(b) is in the same pharmaceutical form as, or in a pharmaceutical form that is appropriate for substitution for, each of the other products in the group; and

(c) has the same route of administration as each of the other medicinal products which fall within the group.

In addition, the Bill provides that the Board is not permitted to add a group of medicinal products to the List of Interchangeable Medicinal Products where, for example, any of the medicinal products cannot be safely substituted for any one or more of the other medicinal products in the group. To further enhance the patient safety aspect of generic substitution, Section 13 of the Bill allows a prescriber to indicate on a prescription that a branded interchangeable medicinal product should, for clinical reasons, not be substituted.

I am satisfied that these provisions address the concerns raised by the Deputy. It is important to point out that generic medicines must meet exactly the same standards of quality and safety and have the same effect as the originator medicine. All of the generic medicines on the Irish market are required to be properly licensed and meet the requirements of the Irish Medicines Board. The Health (Pricing and Supply of Medical Goods) Bill 2012 was published on the 13th of July 2012. The Bill completed its passage through the Seanad on Wednesday, the 19th of September, and is currently continuing its passage through the Dáil. An Implementation Group on Generic Substitution and Reference Pricing has been established and it held its inaugural meeting on the 9th of August 2012. The Group met with the Irish Epilepsy Association, amongst others, on the 20th of November as part of its stakeholder meetings.

Food Labelling

 117. Deputy Mary Mitchell O'Connor Information on Mary Mitchell O'Connor Zoom on Mary Mitchell O'Connor asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if he is introducing legislation to mandate for food nutrition traffic light labelling and when this legislation will be published; and if he will make a statement on the matter. [54688/12]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly Food labelling is currently governed by Council Directive 2000/13/EC (general labelling) and Council Directive 90/496/EEC (nutrition labelling). In November 2011, a new food labelling Regulation was accepted by the European Parliament, Council and Commission. The provisions of this Regulation will be effective from 2014 in most cases, and from 2016 in others.

The main changes proposed include an extension of compulsory country of origin labelling to fresh meat of swine, sheep, goats and poultry, a minimum font size on food labels for ease-of-reading and the introduction of a mandatory nutrition declaration on pre-packed foods. This declaration will entail the presentation of the amounts of energy, fat, saturates, carbohydrates, protein, sugars and salt (per 100g or per 100ml) in the same field of vision, with scope for also presenting per portion. Allowance will be made for the presentation of this information through both Guideline Daily Amounts (mandatory) and Traffic Lights (voluntary).

These changes will further empower the consumer to make healthy food choices. An EU Working Group has now been set up to interpret any ambiguous sections of the Regulation and to provide clarity to all Member States. My Department is represented on this group which has had six meeting so far in 2012. This group is expected to issue its final guidelines in early 2013, soon after which this legislation will be introduced into Irish law. All provisions relating to the nutrition declaration will come into effect in December 2016.

Health Promotion Issues

 118. Deputy Mary Mitchell O'Connor Information on Mary Mitchell O'Connor Zoom on Mary Mitchell O'Connor asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if his attention has been drawn to the media report that pro-anorexia websites are running starvation contests; the action he is taking to tackle this issue; and if he will make a statement on the matter. [54692/12]

Minister of State at the Department of Health (Deputy Kathleen Lynch): Information on Kathleen Lynch Zoom on Kathleen Lynch The internet is an international and worldwide phenomenon which has no borders and no single organisation controlling it. Therefore efforts to combat harmful materials and activities on it can be hampered by the multiplicity of jurisdictions, differing legal systems and differing societal norms. Many of the pro-anorexia websites which the Deputy refers to may be hosted outside of this jurisdiction, and as such, the action that can be taken against them here is limited.

While acknowledging these difficulties, it should be emphasised that there is a self-regulatory framework in place for internet service providers in Ireland. The Internet Service Providers Association of Ireland Code of Practice and Ethics sets out clear guidelines and minimum standards in relation to handling complaints regarding suspected illegal material on-line. The Association is a member of the Government's Safer Internet Advisory Committee which advises the Office for Internet Safety, an Executive Office of the Department of Justice and Equality, on matters of internet safety. I should also mention that the HSE provides funding to BodyWhys, the national voluntary organisation supporting people affected by eating disorders. BodyWhys has in the past indicated that if persons are concerned that a young person is accessing such websites, they should guide them towards healthier, more constructive alternatives such as online support meetings, message boards, etc. offered by reputable organisations supporting people towards recovery from eating disorders.

Infectious Diseases Incidence

 119. Deputy Mary Mitchell O'Connor Information on Mary Mitchell O'Connor Zoom on Mary Mitchell O'Connor asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the concerted action he intends to take to educate and inform persons, especially the young, to look after their sexual health in view of the fact that 320 people were newly diagnosed with HIV here last year; and if he will make a statement on the matter. [54695/12]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly The 2011 figures on HIV and AIDS in Ireland were compiled by the Health Protection Surveillance Centre (HPSC). There were 320 new HIV diagnoses reported to the Health Protection Surveillance Centre (HPSC) in 2011, which is less than the number reported in 2010 (330). With the exception of 2005, this is the lowest number since 2001 (Table 1). 6,287 people have been diagnosed with HIV in Ireland since the early 1980s but this number does not represent the number of people living with HIV (PLHIV) in Ireland, as it does not take factors such as death and migration into account.

  Table 1: HIV in Ireland 2001-2011 (Source: Health Protection Surveillance Centre)

Year No. of new cases Cumulative total
2011 320 6,287
2010 330 5,967
2009 395 5,637
2008 405 5,243
2007 362 4,781
2006 337 4,419
2005 318 4,082
2004 356 3,764
2003 399 3,408
2002 364 3,009
2001 299 2,645


  There were 136 (42.5%) new diagnoses among men who have sex with men (MSM). This remains high and sex between men is now the predominant mode of transmission in Ireland. Heterosexual transmission accounted for 33.8% of new cases (108), down from 63.7% of cases in 2002. In particular, there has been a reduction in the number of cases among people from high prevalence countries. 5% of new infections were among injecting drug users (IDUs) which is slightly down from the previous year (6.6%). 28 diagnoses were in the 15‐24 year old age group (8.8%) and there were three Mother to Child Transmission (MTCT) cases diagnosed in 2011. 119 (37.3%) of the new cases were born in Ireland.

  My Department has established a steering group to oversee the drafting of a National Sexual Health Strategy which will provide a strategic direction for the delivery of sexual health services across the country. It will focus on improving sexual health and wellbeing and address the surveillance, testing, treatment and prevention of HIV and STIs, crisis pregnancy, and sexual health education and promotion. Moreover, the Strategy will be in line with the forthcoming Framework for Health and Wellbeing which will provide a policy framework that addresses the wider determinants of health and health inequalities. The steering group is supported by three working groups whose members come from a diverse range of backgrounds including from NGOs, the HSE and Government Departments and a variety of clinical and academic settings including consultants, GPs, nurses and counsellors among others.

  In December 2011 a National HIV Prevention and Sexual Health Awareness Programme for men who have sex with men (MSM) was launched. The programme targeted younger MSMs with messages designed and delivered by their peer groups and aimed at raising awareness, building self-esteem and equipping them to be able to make safer sex choices. The programme was in line with the recommendations of the National AIDS Strategy Committee’s ‘Education and Prevention Plan, 2008 – 2012’ which provides a roadmap for HIV and AIDS Education and Prevention.

Substance Misuse

 120. Deputy Mary Mitchell O'Connor Information on Mary Mitchell O'Connor Zoom on Mary Mitchell O'Connor asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the concerted action he intends to take in view of the findings in the growing up in ireland report that 15% of 13 year olds had tried alcohol; and if he will make a statement on the matter.  [54698/12]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly The National Substance Misuse Strategy Steering Group reported in February of this year. The report contains a range of recommendations to, among other things, reduce the consumption of alcohol in general. These recommendations are grouped under five pillars of Supply Reduction (availability), Prevention, Treatment, Rehabilitation and Research. The Report contains a range of recommendations that impact directly and indirectly on the problem of excessive youth alcohol consumption. My Department is developing concrete proposals on the basis of the recommendations of the report of the National Substance Misuse Strategy Steering Group and these are being prepared for the purposes of submitting them to Government at the earliest opportunity for the consideration and approval of the Cabinet.

Dental Services Provision

 121. Deputy Mary Mitchell O'Connor Information on Mary Mitchell O'Connor Zoom on Mary Mitchell O'Connor asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the concerted action his Department plans to take, in view of a recent behaviour and attitudes study stating that dental health is at crisis point and the finding that the majority of dentists believe that the State dental scheme is not fit for purpose; and if he will make a statement on the matter. [54700/12]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White The Dental Treatment Services Scheme (DTSS) provides access to dental treatment for adult medical card holders. As funding has been capped at the 2008 level of €63 million, the HSE prioritises for treatment patients with special needs, high risk patients and those who have greater clinical needs. A free oral examination every calendar year and free emergency dental treatment with a focus on relief of pain and sepsis are available to all eligible patients, regardless of their medical condition. This includes 2 fillings, all extractions and a number of complex treatments. The National Oral Health Office of the HSE issued Standard Operating Procedures to dental contractors in November 2011 to support equitable and priority funding and provide clearer guidance to dentists on the application of DTSS prior approval requests. The HSE monitors monthly DTSS expenditure and has confirmed that the funding of €63 million will be spent by year end. Given the growing demands and current budgetary constraints, it is not possible to expand the service at present. The HSE will continue to monitor the operation of the DTSS to ensure the most beneficial, effective and efficient use of available resources.

Services for People with Disabilities

 122. Deputy John Browne Information on John Browne Zoom on John Browne asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly when he intends to implement the disability related promises in the 2011 Programme for Government especially individual budgets; and if he will make a statement on the matter.  [54717/12]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly The Government is fully committed to the implementation of all disability-related undertakings in the Programme for Government. In respect of individual budgets, the commitment in the Programme for Government is to ‘move a proportion of public spending to a personal budget model so that people with disabilities or their families have the flexibility to make choices that suit their needs best  ’. It has not yet been determined whether this will require legislative change.

  A personal budget model is one aspect of individualised budgeting, which describes an approach whereby a monetary value is placed on the supports required by an individual with disabilities to live a fulfilled life. It may be implemented in many ways, but the essence of individualised budgeting is that the individual is given more choice and control over how the money allocated to meet their needs is utilised. This approach must be underpinned by a standardised needs assessment to ensure fairness and transparency in the way in which funding is allocated.

  The move towards a personal budget model is encompassed by the recommendations in the recently published Value for Money (VFM) and Policy Review of Disability Services, which addresses the wider area of individualised budgeting and person-centred supports and services. In that context, it is intended that the actions recommended in the VFM Review will lay the groundwork for individualised budgeting, once sufficient analysis of the benefits is carried out in the Irish context and adequate financial management, resource allocation and governance structures are in place to ensure its long-term viability. The priority is to further improve current services, while expediting the analysis of the benefits to be gained from a person-centred supports model and developing the administrative and governance infrastructure necessary for a more accountable and individualised service.

  As part of the groundwork for individualised budgeting, the Health Service Executive (HSE) will be asked to put a structure around VFM implementation activities in the 2013 Service Plan. The immediate priority will be to achieve greater efficiency in the delivery of current services, including improved unit costing, activity recording and financial reporting, with a view to obtaining a more effective use of resources in the first instance.

  The process of evaluating demonstration projects for sustainability and wider applicability will also be put in train. The Department, the HSE and the National Disability Authority have commenced work on the identification of a common assessment tool and the development of a resource allocation methodology, which will provide essential components of the framework necessary to support individualised budgeting and expect to make significant incremental progress on this work during 2013. The allocation of a unique identifier is also necessary to support the delivery of a more individualised service. The Health Information Bill, which is currently being drafted, will provide a legal framework for the use of identifiers in the health system. The Bill is expected to be ready for publication next year.

Domestic Violence Incidence

 123. Deputy Seán Ó Fearghaíl Information on Seán Ó Fearghaíl Zoom on Seán Ó Fearghaíl asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the proposals his Department has made with regard to meeting the administrative and operational costs of a facility (details supplied) in County Kildare; if prior to the development of this facility the Health Service Executive had a clear understanding and agreement with his Department providing the capital funding, the local authority and or the facility provider in relation to ongoing operational costs; his views on whether the funding on offer is adequate to allow the facility to be open; and if he will make a statement on the matter. [54722/12]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly In 2010 the National Strategy on Domestic, Sexual and Gender-based Violence was published. It aims to provide a framework for sustainable intervention to prevent and effectively respond to domestic, sexual and gender-based violence and is lead by Cosc which is the National Office for the Prevention of Domestic, Sexual and Gender-based Violence. The HSE subsequently published its own Policy on Domestic, Sexual and Gender-based Violence. The principal actions are in line with the National Strategy. The HSE’s policy states that a health-focused analysis of violence is crucial, not only because the consequences of such violence require a significant amount of healthcare system resources, but most importantly because the health care system is often the first route through which victims seek to access supports.

Nationally the HSE funds 42 frontline domestic violence service providers. 20 of these provide refuge accommodation and this number has risen from 15 since 2000. The services provide a wide range of supports such as crisis refuge, advocacy and counselling and were funded to the amount of €13.465M in 2012. In relation to the specific query raised by the Deputy, as this is a service matter it has been referred to the Health Service Executive for direct reply.

General Medical Services Scheme Administration

 124. Deputy Róisín Shortall Information on Róisín Shortall Zoom on Róisín Shortall asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the reason sodium chloride for infusion is not reimbursable under the GMS scheme in respect of patients in nursing homes who are not eating a normal diet.  [54727/12]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White I have asked the HSE to supply this information and it will be forwarded to the Deputy as soon as it is available.

Hospital Waiting Lists

 125. Deputy Paschal Donohoe Information on Paschal Donohoe Zoom on Paschal Donohoe asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the hospital in which a person (details supplied) in Dublin 9 will receive an operation; and if he will make a statement on the matter. [54728/12]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly The management of waiting lists for patients awaiting public health care is based on the principle that urgent and cancer patients are prioritised for treatment, then clinically assessed routine patients should be seen in chronological order (i.e. longest waiter first). Should the patient's general practitioner consider that the patient's condition warrants an earlier prioritisation, he/she would be in the best position to take the matter up with the consultant and hospital involved. In relation to the particular issue raised by the Deputy, I have asked the Health Service Executive to respond directly to the Deputy in this matter.

HSE Properties

 126. Deputy Brian Stanley Information on Brian Stanley Zoom on Brian Stanley asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if he will provide in tabular form details of the amount of rent paid by the Health Service Executive on renting property for both administration purposes and service provision in counties Laois and Offaly for the years 2008, 2009, 2010 and 2011.  [54730/12]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly Management of the health property estate is a service matter. Therefore your question has been referred to the Health Service Executive for direct reply.

Primary Care Centres Provision

 127. Deputy Brendan Smith Information on Brendan Smith Zoom on Brendan Smith asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly his plans to develop primary care facilities at a centre (details supplied) in County Monaghan; and if he will make a statement on the matter. [54733/12]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly The Capital Plan 2012-2016 - expenditure for year 2012, has been approved. It contains Exchequer capital provision for the delivery of a primary care centre for Monaghan town to be located at Monaghan General Hospital. The Health Service Executive has commenced the procurement of a design team for this project.

Dental Services Provision

 128. Deputy Sean Fleming Information on Seán Fleming Zoom on Seán Fleming asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if he will outline on a county basis or an area basis in the Health Service Executive the class in which children in primary schools receive their first dental check; the steps he will take to ensure that there is an equal service countrywide; and if he will make a statement on the matter. [54736/12]

 129. Deputy Sean Fleming Information on Seán Fleming Zoom on Seán Fleming asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the year in which children in primary schools in County Laois receive their first dental check; if he is satisfied that this is sufficient and should there be earlier checks; and if he will make a statement on the matter. [54737/12]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White I propose to take Questions Nos. 128 and 129 together.

The Public Dental Service of the HSE provides dental services for children and patients with special needs. In the majority of areas children receive their first dental check between the ages of 6 and 8 years. Currently, in Laois/Offaly, Galway, Kerry and part of Cork (North Lee) the priority is emergency care, special needs and screening of children aged from 11 to 13 years. Once these priorities are addressed and subject to availability of resources, the HSE endeavours to provide screening to children between the ages of 6 and 8 years. The HSE Public Dental Service is currently being re-structured with areas being merged, e.g. Laois and Offaly. It is expected that the new structures will facilitate standardisation of services available nationally.

Medical Card Applications

 130. Deputy Jack Wall Information on Jack Wall Zoom on Jack Wall asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the reasons a medical card was refused in respect of a person (details supplied) in County Kildare; and if he will make a statement on the matter. [54738/12]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White The Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible.

Medical Aids and Appliances Applications

 131. Deputy Caoimhghín Ó Caoláin Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the reason a sensory dynamic orthosis lycra suit has not yet been provided by the Health Service Executive in respect of a person (details supplied) in County Monaghan; and if he will make a statement on the matter. [54739/12]

Minister of State at the Department of Health (Deputy Kathleen Lynch): Information on Kathleen Lynch Zoom on Kathleen Lynch As the Deputy's question relates to service matters I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.

Health Services Provision

 132. Deputy Eoghan Murphy Information on Eoghan Murphy Zoom on Eoghan Murphy asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if he is planning any cuts in budget or service to CoAction West Cork in 2013. [54748/12]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly The level of funding which the HSE will allocate to specific organisations in 2013 will have to be determined by the Executive in the context of the overall level of resources which will be made available to it next year, and priorities identified in the National Service Plan.

Hospital Staff Issues

 133. Deputy Eoghan Murphy Information on Eoghan Murphy Zoom on Eoghan Murphy asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly his views on a possible shortage of suitably trained nurses in hospitals here.  [54749/12]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly At present, some 1650 nurses/midwives graduate per annum from our Universities and other colleges. The Department of Health has recently completed a review of undergraduate nursing and midwifery education programmes. As part of this review an analysis of the number of student places required to ensure sufficient numbers of nurse and midwife graduates was completed. This indicates that the overall numbers of students at undergraduate level meets demand.

The Government has determined that, in line with its commitment to reduce the size of the public service, health sector employment numbers must be reduced substantially in 2013 and 2014. Spending on health services will also have to be very tightly controlled. The cumulative impact of staff reductions from this year and previous years represents a significant challenge for the health system in delivering services. The priority is to reform how health services are delivered in order to ensure a safe, more productive and cost-effective health system.

The changes implemented through the moratorium on recruitment have had an impact on the number of nurses and midwives available. Directors of Nursing/Midwifery will continue to examine closely improvements in flexible working arrangements, changes to rosters, changes to the role of staff and other approaches to minimise impact on patient safety and the quality of care. The Croke Park Agreement has been crucial to the health service’s ability to manage through the very difficult circumstances of recent years. The flexibility and adaptability shown by staff has meant that even with reducing staff numbers, service levels have largely been maintained and indeed performance in relation to Emergency Departments and hospital waiting lists has markedly improved.

The continued reduction in staffing increases the need for reform, including greater flexibilities in work practices and rosters, as well as redeployment and the HSE is committed to fast-tracking new, innovative and more efficient ways of using reduced resources under the Croke Park Agreement.


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