Mr. Derek Tierney:

I will respond to the question about the 1,500 accelerated acute bed plan. Early in April, we engaged with the market through an expression of interest, EOI. That is about understanding whether the market can deliver capacity; it has until Monday to respond. There have been approximately 30 responses so far from Irish, UK and other international companies. There has been a strong response to our EOI. We set out in the EOI that we expect capacity to deliver at least 1,500 beds in total across 15 sites over 2023-24 and at least a start in putting capacity in place within 75 weeks from the EOI. We are currently examining 11 to 15 sites - model 3 and model 4 - with a 24-7 emergency department service, the capacity already delivered across hospitals between 2019-22 and what is in the pipeline in terms of appraisal, funding and permissions. We are also examining, as the Minister said, known bed pressures using data about bed utilisation rates projected 12 to 18 months and calibrated for an 85% occupancy rate. Just as important is hospital performance in length of stay and the performance oversight and management group. That process will, I hope, yield 11 sites which will be targeted in two phases for capacity and investment. The capital plan is set on an annual basis within a multi-annual ceiling guideline. Our approach with the Department of Public Expenditure, National Development Plan Delivery and Reform, in the context of this year's Estimates, is to give a broad indication of what will be needed on a multi-annual basis but trying to lock in a commitment for 2024 and beyond. We will, hopefully, within the next three to four weeks clarify or confirm site location, coupled with the response from the market and then start to proceed and engage with the Department of Public Expenditure, National Development Plan Delivery and Reform, local authorities in the relevant area to get on with planning engagement and permission, and with hospital groups and management to start firming up plans. We will present that through engagement with the Department of Public Expenditure, National Development Plan Delivery and Reform and ultimately bring it to Government in the context of the Estimates.

On elective hospitals, the Government decision in 2022 clearly gave the go-ahead to progress Cork and Galway within the overall elective programme context. That was on the premise that we would see operational service start in 2027 or 2028. That is a longer-term strategic intervention, which I would call "the next". Now, there is rapid development of surgical hubs in five locations to support bringing in capacity to reduce waiting lists in the shorter term. There is a next-and-now model for electives and acute bed. The 1,500 accelerated bed plan is designed to accelerate that capacity. In the context of Sláintecare and its requirements to examine demand and capacity through the PA Consulting report published in 2018, it presented two targets: one reform and one no-reform target. Looking at acute capacity at the end of 2022, we are midway. We surpassed reform targets for the end-of-2022 position and are midway to the 2031 position. We recognise that there is more to do and we can see that there is pressure on the system. This is the response to try to face that head on.