Wednesday, 11 May 2022
Ceisteanna ó Cheannairí - Leaders' Questions
Yesterday, I raised with the Taoiseach the real and serious concerns held by many regarding the ownership of the new national maternity hospital. The Taoiseach dismissed these concerns again and doubled down on his characterisation of this issue as a "red herring". However, last night in a letter to the Oireachtas Joint Committee on Health, two HSE board members, Professor Deirdre Madden and Dr. Sarah McLoughlin, restated their strong opposition to the ownership deal. In the letter, they describe the ownership deal as "unsatisfactory" and state:
While the shares have since been transferred from the [...] Sisters of Charity to a new company, St Vincent's Holding CLG, we believe that in the interest of the public trust and confidence in this new project, there should be absolute clarity on the separation of Church and State.
They go on to observe that the necessary public trust and confidence "would be better achieved if the State owned the land on which the hospital [will be] built". Now that comes from two eminently qualified professionals who were centrally involved in planning for the new maternity hospital. Their concerns, it must be said, mirror those held by many of us on the Opposition benches and, indeed, by many Deputies on the Government benches, as well as by people right across society.
I put it to the Taoiseach that the best way to allay fears and to resolve this problem is for the Government to secure full public ownership of the land and for us to have a clear transaction in which the St. Vincent's Healthcare Group, SVHG, transfers the land directly to the State. That after all, was the initial promise or undertaking from the Sisters of Charity. This would provide absolute, airtight clarity. It would ensure the best protection of the State's interest in what will be a very expensive project. Additionally, it would ensure it is the State’s health authorities that set the range of and the clinical governance for services provided at the hospital.
I think this is just a matter of common sense, but the Taoiseach has pushed back against this common sense in claiming that the current labyrinthine arrangements amount to public ownership. They do not. Repeating the refrain of a "tenner a year" does not change that reality. There is no doubt in my mind that the St. Vincent’s Healthcare Group has to move. It must step up to find a resolution to this issue, but this Government must also step up. Through inaction, the Government will be acquiescing to and colluding in a deal and an arrangement that does not fully protect the public interest.
Tá bunús maith leis an imní maidir leis an ospidéal máithreachais nua. Léiríonn na saincheisteanna tromchúiseacha a léirigh an tOllamh Madden agus an Dr. McLoughlin go bhfuil an imní chéanna ar dhaoine ar fud na tíre. Is é an bealach is fearr chun an fhadhb seo a réiteach ná don Rialtas úinéireacht Stáit ar an talamh a aimsiú. We all want to see this hospital built and built quickly. It can and must represent a huge step forward for the modern, progressive healthcare that women in Ireland deserve. Therefore, I put this proposition to the Taoiseach again in the hope, more than the expectation, that I will get a clear answer. Will he, the Tánaiste and the Minister for Health get around the table with representatives of the SVHG and convince them to transfer that land directly to the State?
Ar dtús báire, tá na geallúintí dleathacha ann ionas go mbeidh gach seirbhís atá dleathach sa tír seo faoi láthair agus sa todhchaí ar fáil san ospidéal nua. Níl aon amhras faoi sin agus tá comhairle dhleathach faighte agam féin agus ag an Rialtas gur sin an scéal. Is turas fada a bhí ann go dtí an lá seo. Caithfidh mé é sin a rá. The 300-year lease at €10 a year is effective ownership. I have received legal advice to that effect. It is ownership. Deputy McDonald may disagree, and it is her entitlement to disagree. I have read the letter from Professor Madden and Dr. McLoughlin. They make the point that at the time of the HSE board's decision on 14 March 2022, the transfer of shares in SVHG from the Religious Sisters of Charity had not occurred "and we held concerns regarding realisation of that transfer". They go on to state:
While the shares have since been transferred from the [Religious Sisters of Charity] to a new company, St. Vincent's Holding CLG, we believe that in the interest of the public trust and confidence in this new project, there should be absolute clarity on the separation of Church and State.
Now there is absolute clarity on the separation of church and State, and that is contained in the constitution of the new hospital, which has reserved powers. Those make it very clear that there can be no "religious ethos or any ethnic" or other consideration in the deliberations of the hospital. That is clear in the reserved powers in the constitution of the hospital. The Minister's golden share gives him or her the power to enforce and to oblige the directors to follow through on those reserved powers and implement them. Additionally, the operating licence given by the HSE to the new hospital board also puts that obligation in place.
What I do not get, and what no one has answered to date, and I asked this last week as well, is how there is differentiation in the context of a 300-year lease at €10 a year and ownership.
I have the conditions here, so let us not pretend it is €850,000; it is not. If you read any of the conditions on the lease, they are normal conditions that would apply to everybody. The tenant with prime responsibility for the funding of public hospitals remains the tenant under the lease. That is not an imposition. There is no change to the permitted use without the consent. That is not an imposition.
I am not talking to you, Deputy. It is going to be built as a hospital. I have read it all. There are no impositions in this. It is basically saying "Go and build a maternity hospital". Let us for the sake of clarity accept that. Let us not try to cloud in terms of the conditions of this. None of these are an imposition on the maternity hospital. In fact, it is a co-location. The question I want to put to the Deputy is that nobody has explained to me how the difference between a 300-year lease at €10 per year and outright freehold ownership materially affects the governance or the clinical, operational or financial independence of the hospital. Nobody has actually explained the how of that to me. People might not be happy. They might want freehold versus leasehold but there is no clear indication, following the articulation of that view, as to how that materially impacts, in real terms, on the operational, clinical or financial independence of the new maternity hospital. Yesterday, I quoted a letter from the ten directors of midwifery services and assistant directors. The Minister has also received correspondence from a very significant number of midwives - all the directors of midwifery in all of Ireland's maternity hospitals - and they are unanimous in their support for the move of the national maternity hospital from its current inner-city location to a new purpose-built world-class facility on the campus of St. Vincent's University Hospital, Elm Park.
As the Taoiseach knows, for a very long time, midwives, clinicians and all concerned - and women of course - have been very much in favour of a new maternity hospital and proper investment in maternity services. That should not surprise any of us. The Taoiseach said there is an unanswered question. Let me put this to him. He says that €10 a year for 299 or 300 years is effective public ownership. The question is this. That being the case, why is it that there has not simply been a clean transaction and a transfer of this land to the State? That is actually the question. If the Taoiseach is saying that it is public ownership in all but name, why is it not full public ownership? That is the first question. The second question is this. Given that the State is the key anchor of the voluntary hospitals, including St. Vincent's University Hospital, which receives substantial State money, the Government has a very powerful hand to play. Why is it that the Taoiseach is resisting my very reasonable request-----
I have led from the front on this. I have asked the Minister for Health over the last year to get this issue resolved once and for all because it has been going on since 2013. The previous Minister for Health, Deputy Harris, brought in Kieran Mulvey, for example, to bring all the parties together. Let us not pretend there has not been detailed, exhaustive engagement between all parties to this over the past nine years. We have led on this and I am determined that we get something done and get the hospital built for the benefit of women and newborns.
In relation to the Deputy's question, there is an argument in terms of the integration of a massive tertiary hospital that is currently on the site. This is going to be a campus, including the existing tertiary hospital and the maternity hospital. It needs to work. I can understand where the St. Vincent's Healthcare Group is coming from on that point. I might not agree with it but I can understand. I do not see a big mystery or conspiracy there. I genuinely do not.
An Bord Pleanála is in the midst of the biggest crisis in its history. Its independence, professionalism and integrity are all in question. Allegations concerning serious conflicts of interest on the part of the deputy chair of the board, Paul Hyde, were first published in The Ditch on 13 April. On Friday, Mr. Hyde admitted overseeing a planning appeal from his sister-in-law, claiming it was inadvertent. He stepped aside on Monday pending investigations. Yesterday, the Taoiseach told the Dáil that Mr. Hyde no longer has access to documentation or the electronic system since he stepped aside. Are we to understand that he retained that access up until then? It does not exactly scream "best practice". Best practice is not a phrase regularly associated with An Bord Pleanála these days. In 2020, it spent a whopping €8 million, which is a quarter of its €31 million annual budget, on legal fees. This is perhaps unsurprising given that the High Court is the only forum to appeal strategic housing development, SHD, decisions which bypass local planning authorities and go straight to An Bord Pleanála.
How is An Bord Pleanála faring in these cases? It does not appear to be faring very well. Of the 40 SHD judicial reviews decided so far, An Bord Pleanála has successfully defended just three. Any planning authority spending 25% of its budget defending its decisions in court and losing a majority of them has a serious credibility issue. Legal fees may be soaring but housing supply is not. Of the approximately 70,000 SHD units permitted to date, commencement notices have been submitted on just 13,000. The planning system may be fast-tracked but the permissions, once granted, are not. Is it any wonder when there is no real penalty for not doing so?
Meanwhile, 82% of all new residential schemes either applied for or granted in Dublin city in 2020 were build to rent. This is a disaster for Dublin, which is a conclusion that everyone in Dublin City Council seems to agree on, both councillors and officials. Somehow, the Taoiseach does not. He thinks any supply is good supply, even very low-quality, unaffordable build-to-rent development which is cannibalising residential supply in Dublin. What is the Government's answer to sluggish build to supply? It is to gift developers €144,000 per apartment without asking for anything to be taken off the sale price. I could not believe this when I read it. I just did not think it was real.
Who made the decision to leave Mr. Hyde in situ for two weeks despite the Minister ordering a senior counsel to investigate those allegations and An Bord Pleanála ordering a mammoth audit of its work? When can we expect to see the terms of reference for the Remy Farrell investigation? Will they be extended to other board members and will the investigation look at the members' interests?
There are a number of questions there. I take it is the Bord Pleanála issue because I could deal at length with the housing issue. As I said yesterday, and I thank Deputy Murphy for raising the issue, the Minister for Housing, Local Government and Heritage, Deputy Darragh O'Brien, is aware of the allegations that have been made. He understands those allegations are currently being denied by the board member concerned. A senior counsel has been appointed by the Minister to provide a report in consideration of this and those terms of reference and timelines are currently being finalised.
As I said yesterday, separate from the allegations that have been made, the Minister has also been made aware of correspondence between the deputy chairperson of An Bord Pleanála, Mr. Paul Hyde, and the board's secretary, which was brought to his Department's attention by the chairperson of An Bord Pleanála. This concerned a conflict of interest disclosed by Mr. Hyde on 3 May 2022 in relation to a May 2021 board decision. Mr. Hyde states in his correspondence that he only became aware of this conflict of interest on 28 April 2022. The Minister then requested a report from the chairperson of An Bord Pleanála when he became aware of this matter on 6 May 2022. The chairperson responded to the Minister on 9 May 2022 that Mr. Hyde has agreed to absent himself from his duties as deputy chairperson for the time being, on a strictly without prejudice basis, pending completion of the chairperson's analysis of the matters raised. I then said that in this context Mr. Hyde will not be in attendance at the offices of An Bord Pleanála, have access to the electronic systems or documentation of An Bord Pleanála, and his case files have been reassigned to ensure the efficient discharge of the functions of the board.
The Office of the Planning Regulator, OPR, has independently written to the chairperson of An Bord Pleanála requesting him to outline the systems and procedures that An Bord Pleanála has in place to ensure effective compliance with statutory duties provided for in the planning Acts regarding the declaration of interests and any other information he considers relevant. I understand An Bord Pleanála has responded to this request, and the Planning Regulator is considering the response.
An Bord Pleanála is independent in its performance of its functions under the planning Act. Pending the outcome of these considerations, it is important that we allow for the completion of the reports to make more informed comments in the aftermath. Needless to say, all board members are required to make a declaration of certain interests under section 147 at least once a year, and the register of interests is available for public inspection. Under section 148, where a member of the board has a pecuniary or other beneficial interest in, or that is material to, any appeal, contribution, question, determination or dispute that falls to be decided or determined by the board under any enactment, he or she shall disclose to the board the nature of his or her interest and shall take no part in the discussion, consideration or decision-making in regard to the matter. There have been amendments to the legislation. To ensure the improvement of legal capacity within An Bord Pleanála, additional resources have been provided by the Minister. We are not satisfied with the level of litigation in the first instance, nor are we satisfied with its outcomes.
This is a very serious matter concerning An Bord Pleanála, not least because it ceased to be the planning appeals board regarding SHDs. It became the decision-maker on housing applications of 100 units or more, bypassing local authority development plans, in respect of which there is a statutory function and one in which the public is engaged. There is a serious loss of confidence in An Bord Pleanála. Confidence in its integrity and professionalism has been completely undermined. Will the terms of reference be wide enough to include other personnel if anything is identified? Will members’ interests be reviewed in the context of the terms of reference? When will we see them? What is the timeline for dealing with the matter? It was not An Bord Pleanála that sought to deliver on the SHDs; the function was given to it. Therefore, there is a responsibility on the Government to ensure the integrity of An Bord Pleanála is not undermined. There has been a really serious undermining of our planning system.
The Minister has acted quickly and promptly on this and has appointed a senior counsel to provide a report on the specific issue. The terms of reference are currently being finalised. I assure the Deputy there will not be any undue delay in respect of that because the independence of An Bord Pleanála, as defined in the Planning and Development Act, is important in itself. Also, it has to be beyond any perception of potential inappropriate behaviour or a failure to disclose. I am not making any judgments on this. I want to stress that because what I am saying is without prejudice to the production of the report itself. We have to be fair with regard to that aspect.
From my understanding, the senior counsel will be focusing on this, but I will revert to the Deputy on it. As soon as the terms of reference are finalised, they will be published. Thereafter, there will be a report. I am sure the Minister will continue to give this serious consideration.
Despite billions of euro being pumped into the health services, our system still fails to meet the needs of service users. There is not just one reason for this. A myriad of issues combine to paint a picture of endless waiting lists, patients on trolleys, the inability to retain and recruit professional qualified staff, front-line staff burnout, under-resourced carers and mental health services, ambulances idling outside accident and emergency units and overburdened general practitioners.
While there is a consensus that Covid wreaked havoc on our health services, it cannot be denied that the system was in disarray prior to the pandemic. The health system has been inefficient for years. Covid is the latest reason being used to mask that reality. Close scrutiny would reveal that billions of euro invested in health services long before Covid have not yielded the results intended. The national picture shows outpatient waiting lists with in excess of 600,000 adults and children. A further 75,000 are on inpatient day-case waiting lists.
A week ago, I raised with the Taoiseach the fact that Limerick regional hospital recorded the highest number of triaged patients waiting on trolleys since records began. An expert group has been assigned to investigate the situation in Limerick. An independent expert group should be appointed to assist health services nationally. Every aspect of this dysfunctional service should be dissected and explored. The implementation of Sláintecare is limping forward.
In my constituency, Tipperary, we face the same issues and frustrations faced in every other constituency in the country. Every single day, my office receives calls from people pleading for medical care for themselves, their families and, increasingly, their children. An example of the neglect is the fact that people in south Tipperary suffering from Parkinson’s disease are desperate for neurological services. There is no neurologist, nor are there Parkinson’s nurse specialists. Ireland has just 30 neurologists, fewer per head of population than Mongolia. We rank 33rd in the world in the provision of neurologists. South Tipperary lies at the bottom, with no neurologist at all.
The HSE’s model-of-care documentation states we need 140 neurological nurse specialists. We have 42 nationwide. Neurological nurse specialists are vital to Parkinson’s patients. South Tipperary patients have been campaigning without success for this service since 2016. Parkinson’s disease is the second most common neurological disorder in the world, second only to dementia. The lifetime risk of developing Parkinson’s now stands at one in 15. It is the leading source of disability.
The billions of euro invested in the health service over recent years must be scrutinised. Why is it that we cannot see or measure improvements as a result of massive investment? Many in the HSE with first-hand knowledge tell me the service is going from bad to worse. When will the Government insist on holding the HSE to account and act on that?
I thank the Deputy for raising this matter. I fully accept the huge challenges and pressures on the health service. On the question on why we cannot measure the improvements in the service, I wish to make a general point. There have been dramatic improvements in health outcomes over the past 20 or 30 years. In 2000, we were 16th in the EU league table regarding life expectancy; this year, we are number one. That is because of a combination of factors, including public health measures, in addition to the significant investment in health services, cardiology care, cancer centres, stroke centres and so on. These are having an impact but sometimes we forget about all that, which is understandable given the very high pressure on accident and emergency departments and hospitals. Coming out of Covid-19, the pressures are enormous.
Let me make another important point. Our population has increased from less than 3.5 million in the early 1990s to 5 million today. That is going to grow. The next census will be interesting. The population increase is having an impact on our services. I argue that, in recent decades, we may not have fully accounted for that in terms of the expansion of services and bed capacity.
A team has gone into University Hospital Limerick. I accept the Deputy’s points on that. With regard to the waiting list, the Minister has outlined a plan. Many people stayed away during Covid but have come back in significant numbers. Obviously, there have been delayed diagnoses and all that. An allocation of €350 million has been made to improve waiting times in 2022, on top of an annual core funding budget that is now €6 billion higher than in 2018. I take the Deputy’s point that there needs to be constant analysis of the additional funding and its connection with service increases and outcomes. There are very extensive aims. By the end of 2022, the Minister wants the number of patients on active waiting lists to be at its lowest in five years.
Every patient waiting more than six months for 15 high volume procedures will receive an offer of treatment by the National Treatment Purchase Fund, NTPF, in 2022. The 15 high-volume procedures such as, for example, cataracts, cystoscopies and hip replacements, represent about a third of people currently on active waiting lists. Treatment will be offered to all 75,000 patients on the active inpatient and day patient waiting lists at the end of 2021 by the end of 2022. We will ensure 1.7 million patients will be removed from waiting lists for scheduled care in 2022. They are very challenging targets and aims. Funding has been provided in respect of that plan and also the winter plan.
That said, the Deputy's point on neurology and Parkinson's disease is well made. The neurology services in Tipperary University Hospital are a hub-and-spoke model that are part of the wider neurology service in Cork University Hospital. The HSE has advised that Tipperary University Hospital recently submitted a business case to the South/South West Hospital Group for consideration for the appointment of a consultant neurologist and a CNM2 clinical nurse specialist. I will follow up on that.
I ask the Taoiseach to expand on his reply in regard to the neurology service in south Tipperary. The inability to retain and attract medical professionals to work in Ireland is given as the key reason for medical deficiencies. We hear that constantly. A high percentage of our young and newly qualified doctors and nurses choose to leave the country to work abroad. Many make this decision after a short period working within the Irish health service. Last year alone, 391 visa applications were granted to Irish doctors to work in Australia. The high cost of rent in our cities and towns is a key factor for emigration. Younger medical professionals are struggling to make ends meet. Front-line staff are frustrated and demoralised. A significant number of older staff have retired, taking with them experience and skills. Older staff retire because of stress and burnout from working in our hospitals and medical practices. This is a key area that must be tackled. If we cannot attract and retain healthcare staff, we will make no progress with the waiting lists and problems we have.
It is important to retain healthcare staff. Many current staff in our hospitals are senior and experienced, and have garnered experience and expertise overseas. There has always been that balance. There should be better retention in the early years of those who have gone through our medical schools. That considerable investment by the State should be retained in our hospital system to a far greater degree than is currently the case.
On the neurology question, the HSE is now working closely with the Tipperary University Hospital management team on the provision of neurology services. The application that has been made for a shared appointment between Cork University Hospital and Tipperary University Hospital, in addition to a CNM2 clinical nurse specialist, is being very actively examined. The HSE and the South/South West Hospital Group are working with Tipperary University Hospital on neurology services in Tipperary. That will represent a significant improvement in the care patients will receive when attending with neurological disorders. I will follow up on that and make sure it is brought to a conclusion.
I return to an issue I previously raised with the Taoiseach, namely, the delays in completing apprenticeships. During the Covid response, the SOLAS block was postponed and delayed, which led to a huge backlog and waiting list for apprentices. The Taoiseach told me last September that there would be considerable Government investment, and I take it that there has been. SOLAS has confirmed to me that it is working at full capacity. The problem is that full capacity is inadequate to clear the backlog. It is like saying the University of Limerick is working at full capacity so what is the problem. The problem is that full capacity is inadequate.
There are still huge delays in completing electrical, plumbing and carpentry and joinery apprenticeships. All of those are important skills for the very ambitious plans of the Taoiseach's colleagues, the Ministers, Deputies Darragh O'Brien and Eamon Ryan, for retrofitting. We need to get people into these areas as quickly as possible, and get as many people as possible into them. We are not achieving that. We are at full capacity but the waiting lists remain unchanged.
I received an email from a constituent about his son. He is two years into an apprenticeship and is still waiting for the seven-month SOLAS block. After he completes that, he has to do two blocks in college. It will, therefore, be seven years before he will have completed what started out as a four-year apprenticeship. He made the point that that is longer than doctors or barristers have to study for. That is fair enough. There is also a fair enough analogy to be drawn in that, notwithstanding all of the difficulties posed by Covid, in particular the difficulties in health settings, clinical studies, laboratories, etc., there were not and are not the same delays and backlogs in completing a medical degree that apprentices are now encountering. My constituent's son is contemplated leaving the country.
Working at full capacity may not be enough. We may need temporary extraordinary measures to clear these backlogs. Those on whom we are relying to carry out the very ambitious plans the Government is setting out are contemplating leaving the country because they are frustrated by the lack of progress in being able to complete an apprenticeship. There is, of course, a huge difference in what apprentices and qualified carpenters, electricians, joiners, plumbers, etc., are paid. The reason many people do apprenticeships is that they will be able to earn a living and get on with their lives after a fixed period of time. The goalposts are changing before their eyes. They are getting frustrated. The Government needs to deal with this and I would like to know what it has planned to do.
I thank the Deputy for raising what is a very important issue. We cannot make Covid, or its impacts, disappear. I am not suggesting the Deputy is saying that but we cannot do that. Unfortunately, Covid has had impacts across all aspects of activity and lives.
That said, we had a record 8,607 apprentice registrations in 2021. We are well on the way to ensuring that our 2025 target of 10,000 registrations per annum is very much realisable. Registrations in 2021 show an increase of nearly 40% compared with 2019. There is real traction here. Craft apprentice registrations have experienced a marked increased in interest over the past four years. The increasing recognition of the value of these employment options means that strong registrations are continuing, with more apprentices coming through the system for placement on all phases of their training.
As of Monday, 2 May, there have been 2,056 registrations this year, comprising 1,794 craft and 262 new consortia-led apprenticeships. The total apprentice population as of last Monday is 23,981. I can go through all of the funding that is provided. The grant scheme of €2,000 for employers of apprentices on consortia-led programmes has worked.
On the backlog, a number of agreed reform measures are being implemented to try to clear waiting lists. These include changed delivery structures for phase 2 off-the-job training in the three programmes with the largest waiting lists, namely, electrical, plumbing and carpentry and joinery apprenticeships, in order to facilitate a third intake of apprentices per annum. An opt-in rapid employer assessment at phase 7 on the job was completed for apprentices who had finalised phase 6 and spent more than four years in their apprenticeships.
More than 8,400 apprentices, or over 70% of those who were delayed in their training by Covid-19, have now progressed in their off-the-job training. This includes over 700 final year apprentices who have been fast-tracked to complete their qualifications. The backlog is tackled in order of those apprentices who have been waiting the longest. Over 700 apprentices who are in the final stages of their apprenticeships were supported to complete an accelerated final phase of workplace training and are now receiving their qualification.
As of the end of March, significant numbers of apprentices, over 7,000, were still waiting to access phases 2, 4 and 6. I do not in any way understate the issue here. Phase 4 lists have decreased significantly since January. It is expected that craft apprentices waiting for off-the-job training for phases 4 and 6 are on target to be cleared by mid-end of 2022. The majority of phase 2 waiting lists are targeted to be cleared by the year end of 2022.
The CAO website opened the system for the first time for apprentices on 5 November. The number of visits to apprenticeship.iedirectly from the CAO options page is up to 28,201.
Generally, I am open to see what more we can do to accelerate programmes without diluting too much their quality.
I completely agree that we need to ensure the quality remains the same but I ask that it be done in medicine, which is very important, as is building. We know what bad quality building results in. We are living through it now and the Government has to deal with its consequences. We do need people coming through. The Taoiseach cited many figures relating to new apprentices coming in but it is about those who are in the system. I appreciate that measures are in place, but I urge the Taoiseach to try to ramp them up because even if the backlog for stage 2 is cleared, does that backlog then continue through the system? Do the apprentices ever catch up on that delay or do they just get on to the next stage, albeit a year and a half later, and are then a year and a half late throughout the system? If the latter is the case, it is profoundly unfair. A way needs to be found to ensure that, even if the apprentices who started off to do a four-year apprenticeship cannot complete it in four years, at least they are not looking at seven years because that would be entirely unfair to them. I think the Taoiseach and I agree on that at least.
That is a fair point. I will speak to the Minister again to see what can be done in respect of the seven-year timeframe the Deputy is suggesting. It is a fair point.
The Deputy is saying that at the moment people may have to go seven years, which would be too long. We did not close down medicine during Covid. I am not saying that facetiously. We did close down construction twice - in the first and second lockdowns - which had impacts.
In the case of medical studies, many doctors were in hospitals and gained different types of experiences. We did not close that down. I take the Deputy's point. It is valid but there are specific-----
The Deputy is aware that I have been involved in apprenticeship as a Minister in different capacities. There are specific block periods of release that apprentices have to do, with specific facilities and all of that.