Ms Suzanne Costello:

I will go back to Dr. Kavanagh and Dr. Mack in a moment, but it comes back to the structures, plan and roadmap. We have mature organisations with established relationships, but in some ways we have reached the limit of our remit. Perhaps a review of that remit, revisiting what is possible 27 years on from what was originally envisaged, would be worthwhile. There is greater potential now than perhaps there was at that time. Many things have happened that have affected public health since then, not least the pandemic, and there are significant lessons from that. There has been significant investment in public health medical consultants in the HSE in recent years and that has been welcome. Part of the focus on the need for a multidisciplinary approach is a result of those colleagues mapping out what they need to move forward. I think a public health strategy may be coming forward.

A lot of work is ongoing, but in the North-South space, if the committee is minded to do so, it could set out some clear goals that are achievable. Things like the public health data set sound like enormously complex and difficult things to do, but it is relatively easy - we wrote a scoping exercise on this - to start with a pilot to just work in one area of health improvement. There are many topics that both jurisdictions are extremely advanced in, particularly tobacco control. That would be a good starting point and we could build from there. Sometimes, if we think about something that is so enormous, it is just too big, too complicated and too expensive for anyone to take on. In the landscape of health where there is so much acute pressure all the time, one of the challenges is to carve out time and space to think strategically about five, ten or 15 years hence because that is the space health improvement is in.