On behalf of the committee, I welcome Ms Gina McIntyre, chief executive and Mr. Chris Kilpatrick, senior communications manager, special EU programme body of PEACEPLUS. I also welcome Mr. Pat Healy, director general; Ms Cathy McCloskey, chief officer; and Ms Paula Keon of the EU North-South office, Coperation and Working Together, CAWT. Ms Abbie McCarthy and Mr. Brian O'Toole are here with them. We look forward to their engagement with the committee and the opportunity to engage with them on the impact of PEACE funding on local communities, the cross-Border challenges on healthcare and the PEACEPLUS interventions to address them. We look forward to hearing about the practical steps taken, the lessons learned and the added value and impact of co-operation on projects in local communities. The format of the meeting is I will invite Ms. Gina McIntyre and Mr. Pat Healy to make an opening statement. This will be followed by questions from the members of the committee. Each member has a five- to seven-minute slot to ask questions and for the witnesses to respond within that time.

Before we begin, I remind members of the constitutional requirements that in order to participate in public meetings, they must be physically present within the confines of the Leinster House complex. Members of the committee attending remotely must do so from within the precincts of Leinster House. This is due to the constitutional requirement that in order to participate in public meetings, members must be physically present within the confines of the place where parliament has chosen to sit. In this regard, I ask that for any member partaking via Microsoft Teams, prior to making their contribution to the meeting, they confirm they are on the grounds of the Leinster House campus.

Members and witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity, by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, I will direct them to discontinue their remarks. It is imperative they comply with any such direction.

As the witnesses will probably be aware, the committee will publish their opening statements on its web page following the meeting. MPs participating in this committee session from a jurisdiction outside of the State are advised they should also be mindful of domestic law and how it may apply to their participation in meetings. I invite Ms Gina McIntyre and Mr. Pat Healy to make their opening statements.

Good morning to the Leas-Chathaoirleach, Deputies and Senators. I thank the committee for the invitation to talk to it today. I very much welcome the opportunity to update the committee on the progress of PEACEPLUS and in particular, the cross-Border work supporting health and well-being across Northern Ireland and the Border counties.

For more than three decades, the PEACE and INTERREG programmes have helped communities here deal with the long embedded consequences of conflict. Each phase of those programmes took us a step further, with support developed to reflect changing need. PEACEPLUS now brings this work together in a single programme, with a value of €1.1 billion. It is designed to leave a legacy of shared prosperity and stability and will touch the lives of over 600,000 citizens. We are extremely privileged to have such a programme and remain very grateful for the continued support from our funders, including the Irish Government. I am delighted to report that we are at almost 100% commitment for the programme.

PEACEPLUS is the most explicit articulation of ecosystem peace building to date. It combines the activity within both PEACE and INTERREG programmes. The PEACEPLUS programme recognises that peace, reconciliation, cross-Border co-operation, economic regeneration and environmental sustainability are deeply interconnected. The programme weaves them all into this ecosystem. It also matures the ecosystem by encouraging more ownership among its constituent parts, designating project delivery partners as co-producers of peace rather than just passive beneficiaries. Health and well-being has always been one of the visible markers of the impact of the conflict. Evidence shows higher levels of addiction, suicide and mental health issues in those communities that experienced the greatest levels of violence and economic disadvantage. That continues to this day.

Research indicates that 60% of adults in Northern Ireland report at least one adverse childhood experience, and nearly one in five report four or more. A significant proportion also report conflict-specific experiences, such as witnessing violence, receiving threats or bereavement linked to the Troubles and the conflict. Children and young people in these areas show higher rates of anxiety and behavioural difficulties. We also know the effects are not confined to those old enough to remember the conflict. Young adults today still report exposure to threat and trauma. Therefore, we also support interventions addressing intergenerational trauma.

We are all aware that these pressures limit life opportunities in many ways. That is why PEACEPLUS includes a healthy and inclusive communities theme, for which we have committed €172 million to reduce health inequalities and strengthen community resilience. The collaborative health and social care investment area alone is expected to support more than 80,000 people. The aim is to develop models of care that can be delivered on a cross-Border basis, make better use of local capacity and help communities overcome long-standing barriers to support. A substantial set of projects has now been approved. They show the breadth of the need in the region and the benefit of treating complex health and social pressures in a joined-up way.

For example, ONSIDE Evolution, is helping people living with disabilities and their carers overcome social and digital exclusion. The community connection and wellbeing project will support 10,000 people and help communities address long-standing pressures on mental health. Early intervention programmes for children, such as the changing lives: flourish and thrive initiative, which the committee saw first hand, will support families dealing with ADHD, ASD and other behavioural needs. The CAWT early frailty intervention project will assist over 8,000 older people through new community-based models of support. Other projects address obesity, diabetes care and medication management, while addiction services such as CAD+ and the SUMIT projects are helping individuals with alcohol-related harm and dual diagnosis access safer community-based interventions.

These achievements build on earlier success. Under the INTERREG VA programme, almost 70,000 episodes of cross-Border care were delivered. Projects such as those CAWT will outline showed how early intervention, trauma-informed practice and digital support can transform outcomes for families, young people, older people and those with sensory impairments. This history really matters. It has produced a well-established trusted network of providers, North and South, who know how to work together, share learning and offer services that neither jurisdiction could sustain as effectively alone. Cross-border healthcare continues to be essential for this region and its citizens. It improves equality of access, creates economies of scale and allows us to maintain specialist services that would be difficult to deliver within one system alone. However, we are realistic about the challenges that remain.

Trauma continues to affect many communities, often reinforced by economic hardship, disrupted education and social isolation. Many groups remain unseen and may feel excluded from decision-making. However, PEACEPLUS gives us the opportunity to address these deeper issues not only through direct health projects but through wider investments. For example, there is more than €100 million in youth mental well-being, rural inclusion, support for victims and survivors and much more. Our region has been on a journey and the strides taken, achievements delivered and lessons learned here can serve as a strategy framework for practical peacebuilding on the international stage. Society in our region rests on the foundations enabled and supported by a lattice of peace-building tools and interventions. That critical work continues as evidenced by PEACEPLUS.

Taken together this programme is providing a renewed opportunity to improve health outcomes, strengthen relationships and support a more confident and inclusive society. It reflects the belief that peace is not only about removing violence but about giving people the chance to live healthy, connected and fulfilling lives.

I thank the Leas-Chathaoirleach and members of the committee for the invitation to meet with the committee today to discuss CAWT. I am joined by my colleagues as outlined by him

The co-operation and working together partnership known as CAWT was established by the Ballyconnell agreement in July 1992. Its current partners are the HSE in Ireland and the Western Health and Social Care Trust, the Southern Health and Social Care Trust, the Department of Health strategic planning and performance group and the public health agency in Northern Ireland. A small staff team works exclusively on cross-Border health and social care activities known as the CAWT Development Centre which is located in the Western Health and Social Care Trust and works across the entire CAWT Border region in both jurisdictions.

The departments of health in both jurisdictions fund the CAWT Development Centre jointly via their respective agencies, the HSE and the Western Health and Social Care Trust. The core purpose of CAWT is to improve the health and well-being of the people living in the Border region and to enable better access to health and social care services within the Border communities. Key CAWT governance structures include the management board, secretariat, strategy groups, project boards and corporate functional groups. We acknowledge the commitment of many health and social care staff to the development and delivery of cross-Border projects often during periods of considerable change and in addition to their day-to-day roles. The CAWT partnership's cross-Border work has been made possible by the essential support of successive EU structural funding granted by the special EU programmes body, SEUPB, through INTERREG programmes previously and now PEACEPLUS. This vital funding has had a tangible impact on health services and on the communities we serve across the Border corridor. I acknowledge in particular the work of Gina McIntyre and her team in supporting these initiatives.

Successive EU INTERREG programme funding for CAWT cross-Border projects has provided treatment or services to more than 100,000 patients and clients, many of whom live in more rural Border areas. Some €73.9 million has been invested in health and social care in the Border region through this programme. CAWT has a strong track record of sustaining EU-funded projects beyond the conclusion of funding. This is due to the strategic alignment of health and social care policy and best practice and by identifying population and community needs in consultation with key stakeholders. Most recently, the CAWT partnership from 2015 to 2023 delivered five large-scale cross-Border EU INTERREG VA health projects totalling €31.5 million with 62 voluntary community partners, over 50,000 beneficiaries achieved and 83% of services integrated or mainstreamed. We welcome the opportunity that PEACEPLUS offers and confirm the CAWT partnership's ongoing commitment to successful implementation of these collaborative initiatives and ongoing good working relationships with SEUPB and key stakeholders.

After considerable preplanning and engagement with key stakeholders in 2024, the CAWT partnership submitted business case applications to the new PEACEPLUS programme under investment area 4.1, collaborative health and social care. Subsequently, confirmation was received that five cross-Border project applications had been successfully assessed by the PEACEPLUS programme steering committee to receive grant funding totalling €42.6 million. This represents the largest overall EU PEACEPLUS funding programme allocation to CAWT partnership to date and brings to a total of €116.5 million all the programmes in which the partnership has been involved. This welcome investment provides a fantastic opportunity to innovate new cross-Border approaches to service planning and to engage with partners in the community and voluntary sector in serving the health and social care needs of our communities, families and service users. The following five projects will be implemented throughout the Border counties in both jurisdictions: geriatric medicine, early frailty intervention project; obesity healthy futures project; mental health adult community connections and well-being project; mental health children early intervention support youth hubs; and addictions community alcohol detox. These projects will have the key common aims of preventing ill health and intervening early, reducing health inequalities, building strong partnerships with the community and voluntary sector and engaging cross-community where this brings added value and supports peace and reconciliation. We will continue to drive forward PEACEPLUS projects mobilising and achieving agreed targets and outcomes as well as evaluation and embedding these initiatives into core mainstream services where there is a clear rationale and benefits.

PEACEPLUS funding is needed now more than ever to consolidate and scale up cross-Border collaboration in health and social care at a time when the health and social care organisations are dealing with increased pressures and changing demographics. The CAWT partnership will also continue its ongoing focus on addressing health inequalities and complementing the work of the shared island initiative and other North-South health and social care activity. We remain fully committed to working collaboratively to deliver high-quality innovative cross-Border health and social care services that improve outcomes for the communities we serve. I am happy to take questions.

I thank both witnesses. We will move on to questions. The first person up is Senator Garret Kelleher.

I thank all the visitors for their attendance. I also thank Ms McIntyre and Mr. Healy for the two very informative presentations.

My first question, to both witnesses, relates to funding and the ongoing sustainability of the vital projects. Ms McIntyre mentioned that meeting the long-term goals is about much more than just having seen an end to violence and that after peace we need to continue on with reconciliation and building bridges.

From the point of view of the PEACEPLUS funding, will she outline the extent to which funding might previously have been received from the INTERREG channel and post the UK withdrawal from the European Union how the shortfall in funding that might previously have been received from Europe is being replaced from the point of view of the long-term sustainability of the projects we are discussing?

The previous INTERREG programme was a lot smaller. We had an INTERREG programme and a PEACE programme. Between the two of them there was about €580 million. Post Brexit there was an agreement between the UK, Ireland, the EU and the Northern Ireland Executive that there would be a continuation of the PEACE programme and PEACEPLUS. Because no EU funds were going to the UK, the UK actually contributed its own amount directly. It goes through the EU system and comes to us. It is treated just like any other EU programme. Currently, we are hoping there is also a commitment to a further programme. Of course, that will be dependent on the EU budget allocation for Ireland and the UK's commitment to providing the money. We are hopeful that there will be an additional programme, PEACEPLUS 2, and we are starting to develop that programme now.

In regard to the timeline, when is it likely the hoped-for funding will be secured?

It will depend on the budget allocation and whether Ireland gets a special allocation out of the budget from the EU. We probably will not know all of that until later on this year. A couple of my colleagues in the Department of public expenditure and reform are dealing with that with the Commission. Negotiations will then start with the UK about-----

It seems Ms McIntyre is satisfied that is not impacting on any decisions that need to be made in the foreseeable future.

Not at the minute, no.

A lot of the projects are really just getting started and we are going to now do the prep work on the needs analysis for the Border region and Northern Ireland and what a future programme could look like. We start that work now and whenever we hear if we have actually secured a budget, we can then work around that.

I thank Mr. Healy for the presentation. We have heard a lot, particularly prior to Christmas, from those who have direct involvement with cross-Border co-operation in healthcare. Regarding the health inequalities he referenced, can he give us any idea of the extent to which there have been reductions in the health inequalities, where it is possible to point at, as a result of the cross-Border co-operation?

What we will see if we look at the particular programmes we are targeting and have targeted, it is very much community orientated and is focused on where there are inequalities. Currently we look at ageing; frailty; obesity; mental health, in particular for both adults and children; and drug and alcohol addiction. They are the five areas we are targeting. That reflects the level of need, because it is a needs-based and needs-driven focus. That was the most considered view, both North and South, of the best areas to target in terms of need. We have demonstrated over the period both in terms of INTERREG and now PEACEPLUS an 83% sustainability. The projects that have started, which were invested in by €116 million to date, have 700 posts including the posts we were talking about putting in now, and of those we have mainstreamed a significant number of those. That is 83% which is very high. That is one of the important benefits of this programme. It creates the opportunity to test and see what is actually working regarding innovation, new ways of doing things, ways of collaborating and then maintaining those on a permanent basis going forward.

Mr. Healy mentioned in his opening address that PEACEPLUS funding is now needed more than ever to consolidate and scale up cross-Border collaboration. Is he satisfied that from the point of view of funding and financing that there are no obstacles for the foreseeable future?

There are none.

That is great.

If we go back to the briefing note I sent in, one of the reasons I did it is we can see how it has continually grown from the first one which was €6 million, then €12 million. We are up at €43 million now. With every programme we seem to get deeper, broader and more substantial. The key is that we are actually developing sustainable models. This model brings collaboration, it brings cross-Border working but it brings real innovation and new ways of working. We can test those and see how best to roll them out on a permanent basis.

I thank Mr. Healy. That is great to hear.

We now move on to Deputy Conway-Walsh.

It is Senator Murphy in our slot.

Who wants to lead?

Senator Murphy.

I apologise. I call Senator Murphy.

I welcome the witnesses and thank them for their presentations. I am going to bring it back to the future money matter. Ms McIntrye said that it would be a matter of what the EU budget was to Dublin and what the British were prepared to contribute. However, the EU has always been a contributor and that is not currently on the table for a future round of PEACE funding. What discussions have there been between witnesses and the sponsoring departments in the North and the South, the British Government and Dublin? Some MEPs, led by our own MEP, Kathleen Funchion, have taken the initiative to write to the Commission and to encourage it to make a contribution to this. Where is all that? Surely, if one leg of the three-legged stool in terms of the PEACEPLUS, PEACE and INTERREG as it was over the years, is removed then that places a significant question over the level of activity that will be able to continue on to into the future.

It is not for me to deal with. I know there are negotiations which are dealt with through the Department of Public Expenditure, Infrastructure, Public Service Reform and Digitalisation and the EU and the Minister of Finance talks to them and the officials directly. However, we are aware that there is an allocation for Ireland in the current budget, which would not be sufficient to produce a PEACEPLUS programme separately. My understanding is that Irish colleagues are trying to secure a special allocation from the EU for the programme. A commitment has been given by the Prime Minister and the Taoiseach to a future PEACEPLUS programme. It will all depend on the funding and what can be made available. The Senator is absolutely right that Irish MEPs are making that case at every opportunity they can and so am I.

In relation to PEACEPLUS, Ms McIntyre did mention in her opening remarks the particular challenges there are among communities. Largely, communities that are economically disadvantaged have suffered the full brunt of the consequences of the conflict in terms of, in this case, health issues but in general terms, economic opportunities and infrastructure. Does Ms McIntyre feel that PEACEPLUS has managed to get down to the ground with these issues? We continuously hear from people - and the committee had the opportunity to visit some project in the North a couple of weeks ago- the difficulty in accessing PEACEPLUS funding for ordinary, grassroots communities that are doing the actual work in the communities that she has identified as needing the most help in terms of funding for peace.

We believe we have been able to get down to the ground level and all the areas that the programme supports because it does support skilling, reskilling, our young people and mental health for our young people. Every council area in Northern Ireland and the Border region has been given a special allocation which they deliver on regeneration, building positive relationships and supporting differences. We believe it has got down to the ground level. When we assess projects, it is all about what they are doing for the citizens and the beneficiaries. The beneficiaries are all on the ground. Those organisations with the capacity should be the deliverers so the organisations and the people on the ground benefit from the money without having to do the paperwork.

Often within the programme we have two small funding areas called change-maker funds and the change-maker programme. There is €40 million in that alone. That is €20 million for cross-community relationships and €20 million for cross-Border relationships. Those projects are under €100,000. They are very much administratively simple. They work on a budget allocation at the beginning. Once we assess the budget and a few quotes for whatever is being asked for, we then work on the basis of milestones. When they deliver, we pay them. We have done that specifically to make sure we can access groups on the ground that had not accessed EU funding before, did not have the capacity for the paperwork and were too small to know how to deliver on big grants, carry that cash flow and all of those sort of issues. That is why we specifically set these funds within the programme to address local needs. It does not matter what the project is about. It can be anything, as long as it is about people coming together, cross-communities building relations or cross-Border strengthening and forging new links. What they come forward with is entirely up to them.

That is at the much lower end of the scale in the entirety of the PEACEPLUS budget. CAWT is kind of geographically restricted in terms of the work it does, which is essentially in the Border counties in the North. In the evidence this committee has been taking in relation to all-Ireland health matters, there remains significant obstacles to all-Ireland health delivery. We have heard of the examples of the Altnagelvin cancer treatment centre and the children's cardiac services between Dublin and Belfast. They are good examples but they are in place maybe 15 or 20 years. We still have a system where the health files of people cannot be shared between the North and the South. There are major structural challenges. While CAWT is doing this work on the ground, the big picture is not changing that significantly. Does it have any input with health departments North and South to say we can run programmes, say for addiction treatment and obesity and all these things that are very valuable in communities, but the big picture in terms of health alignment across the island is not changing anywhere near the pace that it should.

At the moment, there is a reorganisation happening within the HSE with six new regions. In my role, I am national director as well in terms of acute operations, national services and the ambulance service and so on.

The six REOs and I meet regularly with the CEOs in the trust in the North. Over the last 12 to 18 months, there has been really good collaboration at that level. We are looking outside of CAWT at a much broader transfer of learning and opportunities and the type of thing we talked about, which is looking at where there are good systems and how we are doing things in the South or the North and transferring and sharing that learning. We do a lot on the CAWT piece, but we are also looking in a broader sense at where the two health services can collaborate together. We are meeting periodically and systematically and we are focusing on particular areas of interest to both sides. Senator Murphy will see a lot emerging out of that, and there will be a lot of opportunities in that regard in the coming period.

I will finish on this point. The CEOs in the trusts are gone, but the big policy decisions are taken by Ministers, North and South. We can find examples of good practice, but if the Ministers are not in this conversation and nobody at the top level is willing to implement them, North and South, that will not happen. The evidence we hear from clinicians and health professionals is that there are still significant barriers to trying to operate an all-Ireland health system.

We work very closely with the Departments on both sides. That is part of the reason Ms Keon is with me here today. Ms McCloskey is the chief officer of CAWT and Ms Keon is in the North-South unit of the HSE. We use both mechanisms and engage continually. We engage very closely with the Department of Health and its line divisions. We also engage with CAWT and we use the CAWT centre as a mechanism to support us, in terms of the staffing of that. There is a real mechanism there for good collaboration and for developing good practice and translating that practice across both sides.

Does Ms McIntyre want to reply?

The programme was designed and developed in consultation with the two health Departments. We had consultation on the EU objectives right down to the ground level with citizens and we went to public events. In the middle, we had the Departments for health, North and South, which worked together collaboratively. They told us about the areas of priority that overlapped for them but that they could not fund or deal with themselves, and identified the area that they wanted funded within the programme. What we have funded represents that collaboration. We hope that there will be more of it.

I would like to mention as well that we did a bit of analysis across the under-represented groups in programme 1 that we would have expected to have seen being supported within the programme but who were not able to access it or in some cases did not apply. We are going back out with a small call for those groups specifically.

PEACE funding is not about supplementing the Department's spend. It is about genuine transformation.

That is true.

Genuine transformation in terms of all-Ireland health matters is not happening in that space as it should.

I thank the Senator. Senator Stephenson is next. Does she want a couple of minutes to prepare?

Yes.

Senator Black is next and then I will come back to Senator Stephenson and give her a couple of minutes.

I thank the witnesses for coming in today. I love these sessions because it is great to hear about the work that is going on on the ground. It gives me a lot of hope. It is great to hear about the amazing stuff that they are doing.

I know this committee is talking about health today, but I just want to briefly go off subject for a minute and focus on constitutional change, including our call for preparation. Is there any plan for potential constitutional change? I know the Holywell Trust in Derry and the excellent forward-thinking project the witnesses are supporting with it. Is there any kind of focus on constitutional change in general? We are focusing on health and constitutional change. We know that something is going to happen down the road at some point and planning and preparation are vital from our perspective. Is there any kind of planning, preparation or forward thinking around that? That is my first question.

No.

Is that not something Ms McIntyre can kind of look at it or even consider going forward?

Not really, no.

Okay. I just wanted to suss that out.

I see that there is a specific reference to addictions and community alcohol detox. The other area I want to talk about is the impact of addiction on family members. It is an area that I am specifically interested in. Many years ago, I ran a programme with the Family Addiction Support Network, FASN, organisation, whereby we brought family members to Rathlin Island. It was a cross-Border, cross-community programme. It was unbelievable. The group came into the family programme on the island. It was very calming for people to get off the mainland and go to an island. Family members were living in unbelievable turmoil and trauma and had really bad mental health issues due to stress, trauma and anxiety. It was life-changing for them to be brought to an island like that and do a week-long therapeutic programme.

Family members have unbelievable stress and anxiety and that is separate from the person in addiction. Is a project like that something any of the witnesses have done or would consider doing going forward? When we get to the family members and try to give them tools to help them cope with it, that can often impact the person who has the addiction problem and can be life-changing for the whole family. Sometimes, the family member who has the problem can step into recovery because another family member has stepped into recovery. Is that something that the witnesses have considered or that they are doing? The cross-Border, cross-community learning that we got was really amazing. Obviously, everybody came in not trusting anybody, but by the end of the week when people realised they were all in the same boat from the trauma of living with somebody in addiction, the bonding that happened was amazing. The people from the South in particular had no idea about the impact of the conflict in the North, so they had a huge learning from it as well, even though everybody was going through the same thing. I just wanted to find out if there was anything going on in that area.

Yes, we do fund that. We have a specific area within PEACEPLUS for addiction services because we recognise the impact that the conflict and violence have had on our citizens and on future generations because that impact obviously is not just on those who were there at the time. There is intergenerational trauma, and addiction issues and substance abuse go on for many years and go through families for that reason. Therefore, we did specifically look at addressing addiction services. We have one project, which we might talk more about, which is the community alcohol detox project. It is specifically for the families of those people who are dealing with detox. It is also about ensuring that they can stay within their communities while detoxing and not go into an institution. It is specifically for that reason because we heard how difficult it was for the families.

We have another project on substance abuse and mental health interventions using digital technology. Again, that is looking at transformation of the services and the strategies and policies for digitally enabled health and social care services specifically on substance abuse as well.

I might add to that. Specifically on the project, I take the point the Senator makes about recognising that it is more than just the person in addiction themselves, but the wider family and the socio-economic impact in terms of whether there is poverty, homelessness or mental health issues and so on. The project is very much to deal with families as well as the individual. I might ask Ms McCloskey to just talk a little bit more about the specific project.

The community addictions project focuses on people detoxing at home with the support of a nurse-led team. We are looking at a wraparound programme, so it is not sitting in isolation. Again, speaking to people and families who have been on their journey, it is about looking at the supports that they need to have in place to help the individual but also the family. There are going to be wraparound programmes, so it is pre-detox and post-detox. We are going to do procurement exercises with the community and voluntary organisations. It is about that piece where people on the ground can do what we would call hand-holding and giving them the support they need in the space where they are at. There will be programmes for family support as well as for the individual. The programme is based very much on the needs of individual families.

There is a really brilliant organisation in Dundalk, called FASN.

It deals with the families separate to the person in addiction. Even if their loved one is not in recovery, the family need separate recovery because addiction is a family disease, disorder or whatever word people want to put on it. The whole family are devastated by it. Families need their separate recovery.

My concern is that trying to get the family member to help their loved one in addiction is probably not a great idea because they need their own separate recovery. That is important. It is something that CAWT might consider. For example, FASN in Dundalk does not really deal with the person in addiction. It is an unbelievable organisation. For a lot of the family members who come to FASN, their loved ones are still in active addition. It is heartbreaking and the mental health impact is soul-destroying. That is why it is vital that those family members, particularly parents with adult children in addiction, receive separate support and the tools to be able to cope. Sometimes, they cannot even go to work or function and other children in the family are not cared for because the obsession is with the person in addiction. It is something that needs to be looked at and addressed. I ask the witnesses to look at FASN because it is an amazing organisation.

I am happy to look at and reach out to that particular group to see whether there are particular learnings we can transfer and so on.

I am sorry I missed the opening statements but I read over them.

I will link in with what Senator Black said about the challenges with addiction. Ms McIntyre also mentioned intergenerational trauma and mental health. What kind of work is being done, if any, to prevent violence against women? Obviously, since the Troubles ended, we have seen staggering rates of violence against women and girls in the North, including higher levels of domestic violence and an increase in PSNI call-out rates for domestic violence. I know we are predominately talking about health in this session but mental health, intergenerational trauma, addiction and dual diagnoses compound the risk of domestic violence. Is there anything in the witnesses’ work around that to which they could speak?

Yes. We have acknowledged that throughout the whole programme. In all of the letters of award to every project, we ask them to specifically look at and consider the ending of violence against women and girls. In some instances, that may be with regard to an environmental project rather than a community project. In all of the projects, however, there are staff in offices and people who come in. We have asked people to address that in some way to end violence against women and girls, whether that is through posters or awareness raising.

While I do not think we have any specific projects that have come to us in this regard, the change maker funding programme, which awards smaller grants of up to €100,000, is one of the areas where we will be going out specifically asking for projects that will address ending violence against women and girls on a smaller community level. We have done what we can in that regard.

In the programmes, this area is probably more linked to the projects we have developed over the years on mental health. We have tended to have a focus on the area of violence against women as part of those programmes. As Ms McIntyre said, there is an awareness of the necessity to keep a particular focus on that. It is in that sphere that we have given effect to that side of it.

I have another question about the new communities in Ireland. We saw the race riots last year in the North, which were horrifying. How are the witnesses working with those communities and bringing them along in the journey?

In PEACEPLUS, we specially have projects in this regard, such as the migrant councils working together or other projects working with the new communities. We consider communities being the whole community. Rather than it solely being about the traditional religious divide in Northern Ireland, it is also about all the newcomers and what we can do to ensure that they are included in the community peacefully.

The Senator may have missed my comment to Senator Murphy earlier but we have identified some groups that were under-represented across programmes where we would have expected to have seen them represented. In light of what happened last year in Northern Ireland with the race and violence issues, we are looking for projects that address that. With the change maker fund, we will also be looking for projects that help address that, whether that is awareness raising, sharing information or teaching people how they should behave on a local level and what they can do. Sometimes, the simplest of projects can bring people together, such as young people playing football. All of that can be developed under the change maker fund, which grants funding of under €100,000 to projects. We are also looking at the Roma community and under-represented groups, in particular.

Those would be cross-Border as well in terms of-----

Yes, and cross-community.

Brilliant.

All of our projects essentially encompass that aspect. It is very much across the divide. It is intergenerational and complete. We look at on the basis of the totality of the community we are serving.

I have a couple of questions. I thank Ms McIntyre and Mr. Healy. I am interested in what Mr. Healy said, namely, that 83% of projects carried out to date have been mainstreamed. I am keen to hear about those that have been mainstreamed. I will start with that. Will Mr. Healy give us a bit on an idea of the projects that have been mainstreamed to date? What does “mainstream” mean? Does that mean they have now been mainstreamed into key services within organisations, such as the trusts, and investment has followed? I am keen to know that.

That is it. When we start out, the funding is for a defined period of time. The idea then is to ensure it continues and the health system funds it on a permanent basis going forward. In the briefing note we sent, we tried to identify the core projects that have continued on. We have given the detail of the numbers and so on. I can write back specifically on the exact number, if Ms Cullen so wishes.

The important point is that we develop the initiatives on the basis that we will try to support them on a continuous basis going forward. We set them up on that basis, but part of the learning is seeing whether they are sustainable or there is a need to revise or restructure. We learn that as we go. In more recent years, projects have virtually all continued on a permanent basis. That has to do with the planning and consultation that goes in at the earlier stages. We involve multidisciplinary teams, stakeholder groups and communities. The projects we are developing generally are ones that have significant buy-in across the communities we are involved with. They also have identified a niche or a service need that is there. In that sense, they are sustainable going forward.

I am keen to hear about the acute project because it is of particular interest to the South West Acute Hospital. Some of the areas included within that acute project were ear, nose and throat, ENT, vascular, neurology and ophthalmology. Are all of those now mainstreamed within the western trust? Has funding continued on? Is that what Mr. Healy is saying?

Is Ms Cullen referring to past projects that were completed?

Yes.

Projects-----

I refer to the 83% of projects that were mainstreamed. Does that figure include this project?

I might ask Ms McCloskey to answer that.

At the point of the project end, those services were mainstreamed into the existing organisations. When we are talking about something being mainstreamed, we are talking about the mainstreaming of the services into the health trusts. Those elements of the project were mainstreamed at the end of project.

Ms McCloskey is saying that those services should still be in place at this point.

Yes. I do not have the specific details at this point. When we did that exercise, they were mainstreamed into existing services.

In terms of mainstreaming, the community health sync, CoH-Sync, project, where we were working more with the community and voluntary organisations, ended when the project ended. When we talk about lessons learned from previous times, as Mr. Healy said, it is really looking at from the outset what we can predict to mainstream at the end of the projects.

When you look at the span from 1992 to now, we would have mainstreamed projects, but the system would have moved on since then and there is continual change happening within the health system. However, the purpose of this is that when you develop and innovate a model, you hand that over to the health service on either side of the Border, whichever is continuing it on, and you mainstream that. Obviously, we try to ensure that the projects are aligned with the health policies on both sides as we go.

Over the last period in particular, there has been a significant focus on community-oriented projects. The intergovernmental projects that were done were large hospital-based projects. Internationally, the shift is towards sustaining communities and health services within the community. We have had a significant focus on that on both sides and you see that reflected in the types of project we have brought forward, whether they are on ageing, adult and child mental health, detox and so on. They are very much community-oriented and community-grounded services that we have been bringing forward in recent years.

That information is very helpful. I am keen to know a bit more about how the witnesses decide the priorities. You can imagine in an area like Fermanagh and south Tyrone, along those Border areas, that there are multiple priorities for everyone. I noticed that the last evaluation done by an external body talked about needing to develop, I believe, a comprehensive population needs assessment for the CAWT region and then determine the priorities from that. Is that how CAWT determines the priorities? There would always be a feeling that they are determined by people at departmental level as opposed to people at ground level or based on a population needs assessment. Do we have a population needs assessment for the CAWT region that would be used to determine priorities?

I can take that question. The programme itself determines the priorities. They are set out in the call documents in terms of the funding available, and CAWT and others will apply for what we have identified as the need. The way we determine that need is based on, first, the EU objectives for the funding period. Second, we look at the programmes for Government for Northern Ireland and Ireland. We then do a socio-economic study for Northern Ireland and the Border region, identifying need. We take consultations from all statutory agencies and anybody can give us a consultation document, which we did. We received over 400 documents.

As Ms Cullen said, sometimes those priorities are set at a Government level. We went out to every single council area and spoke to people who came along and told us what they needed on the ground. We had over 1,000 people attend those sessions in every single council area. From that, we determined the needs and areas we thought needed to be addressed.

As Senator Murphy said, this funding cannot replace core Government funding. We have to look at those areas that fall within the criteria of the Governments' priorities but cannot be funded for certain reasons, for example, they may be farther down the list, yet they see the benefits of doing them on a cross-Border basis. Particularly in rural areas, that is a big draw for the health side. We determine the need based on all of those pieces, where the Venn diagram overlaps in the middle and what the Departments are saying are within their priorities and, taking everything else into account, they are happy to fund.

The INTERREG programme and PEACEPLUS have provided a really excellent opportunity for these health projects to effectively pilot services to see if they would work in a rural area. In the previous round, many of them were mainstreamed, which shows that they did work, albeit with changes and amendments.

We do not just have the direct health areas. We also have the rural regeneration and social inclusion aspect within the programme. There is over €50 million in that, and many of those projects are very much focused on health and well-being. You would have healthy, active, rural communities. We were particularly keen on rural areas being addressed in the programmes.

In bringing these services into communities, it provides an equality of access to services that can be sustainable. We would have a lot in regeneration and social inclusion, even projects to do with walking, indoor well hubs and fitness programmes. We do a lot aside from the direct health projects.

I thank the witnesses for that.

We now move on to round two. Does Deputy Moynihan want to go ahead? No, we will give him two minutes. I will come back to him after Deputy McCarthy.

Everyone is very welcome. I thank Ms McIntyre and Mr. Healy for their opening statements. I have a few questions and maybe some of them have been covered, but we will see if we can get through them.

For Ms McIntyre first, what are the main delivery challenges facing PEACEPLUS at this stage and what safeguards are in place to protect PEACE funding in the context of future UK-EU tensions?

The main delivery challenge for the programme at this point in time is that EU programmes are notoriously delayed, as they start off for about a year while the regulations are finalised across Europe. That is quite standard. However, this programme was delayed a further year because of the arrangement put in place between the EU, the UK and the Irish Government for the financing and all the rules of the programme. That set us back a little bit and we were delayed. The projects have now got started. However, last year, we unfortunately hit a problem because the UK changed its legislation on procurement, which was not foreseen by anybody. That meant there was a divergence between the procurement regulations required by the EU, which the Irish adopted, and procurement in Northern Ireland. We had almost nine months of negotiations and legal analysis on what was and was not eligible. We are not fully at the end of it yet but that has caused some delays to projects. We also hear that the projects are having some difficulty in recruiting the good staff they need.

Those things have caused a bit of a delay. We are specifically looking at a very significant financial target this year and we are trying to ensure that we meet that target, but in the knowledge that those projects have been a little slower than normal to come alive.

There is also a change in the funding environment. In the past, we would have funded projects and they were prepared to move ahead at risk, as it were, before they had everything finalised. They would start the activity. Projects cannot do that now because they have lost other vital funding and cannot take a risk. Their boards and governance procedures will not allow them take a risk to start a project without having everything in place.

As regards PEACEPLUS funding, there are negotiations under way - I am not party to those - but the Prime Minister of the UK and the Taoiseach have talked about their commitment to a future programme. I think it will come down to budget.

I thank Ms McIntyre for those replies.

What difference has the EU PEACE funding made to front-line health services in Border regions?

All I can say is it is hugely positive. I tried to reflect that in the opening statement and also in the briefing note. In the briefing note, I tried to give the committee a sense of the scale since we started in 1992 and how it progressed.

In the earlier years, I think it was a question of building trust and developing a new way of engaging and so on but now it is quite sophisticated and developed and a really solid partnership. The model is good and the level of collaboration going on is significant at a service level but it is on the front line. Some 40,000 people have been trained, there have been 100,000 patients or service users depending on the service they have been involved in, and there has been approximately €116 million in funding. These are significant figures and services across the Border region.

On the point Ms McIntyre spoke about, there is a rurality issue as well that we are very conscious of. That has been one focus of the programme, as have the issues of deprivation and social exclusion. There is a breadth of innovation. The word "transformation" was used, which characterises what CAWT is about. The building of relationships for me has been one of the most significant things. This is what I was trying to say to the Senator earlier - not only is it cross-Border, but we are starting to work on a whole-island basis. We are two health services. We are partners. There is a huge amount to be learned across the services, whether acute or community, in terms of how we do things, innovation, AI and automation, and that type of thing is starting to emerge now. There will be great opportunities for learning across the board, which we want to take.

That is comforting to hear. It is good to hear the two health services are working so closely together and getting results. Are there services that would not exist without co-operation between the two health services?

If the services we have seen develop had not had the opportunity to be nurtured in this way, they probably would not have got off the ground in the way they have. Maybe they would have developed in the future in some way but the way this has happened and how people have engaged has meant an awful lot. It has built that connectivity and a level of trust and support across the system. That is an important part of the work. That is the type of approach that is transformational and innovative. We find new and better ways of doing things. You can do that in a safe and co-ordinated way and learn, change and implement it on a permanent basis going forward.

Is there something this Government can do to prioritise and secure the funding going forward? Is there anything the organisations need to secure the funding?

I think they are doing everything they can. They are having discussions at ministerial level. Our Department and the Minister for Finance are having those discussions in Europe. Everybody is very aware. It is important to reflect that when we talk about cross-Border health and other areas, they are embedded in peace building. We have seen the impact of the conflict and the trauma because of our past. That is what we are trying to deliver on. This is not a replication, duplication or paying for services that should have been paid for by the Governments. I strongly believe that none of the projects, CAWT or any other areas we fund would have been funded within the Governments. One of the criteria for a project to be within our programme is it cannot be funded by the Governments even though that may have been the wish. It is important to reflect that we have been moving this programme as the community and needs have changed and as relationships have developed. It takes four generations to remove toxic trauma. We are only 25 or 26 years past the Good Friday Agreement. We are strong advocates of a future programme simply because we are getting deeper and deeper into the issues.

I apologise for being late. I have another committee meeting at the same time.

I would like to focus on the workforce side of the story in terms of the overall delivery, for example, workforce mobility, retention and sustainability, and some of the risks already identified. Will CAWT tell us about the interplay and considerations on that in overall service delivery?

For us, a key thing is multidisciplinary working across the board. Community and voluntary sector involvement is also a huge part. If one is to sustain services into the future, the involvement and support of local communities is key. They are also key in developing the needs-based assessment. We work closely with people. In these current projects, there are 145 full-time equivalent posts. My expectation is that they will all become permanent sustainable posts going forward.

On what Ms McIntyre said, these are models and types of service we would not otherwise have. That is a key part of it. The way this model is developed helps us to secure services and address inequalities and disadvantage in a way that the normal health Estimate process and planning process do not get to. Equally, we have to take account of the training and development as part of that, which is why they are built into many of our projects. The people you work with have to be developed and you have to build a workforce you can sustain. These are key parts of what we plan and go into the development of these projects.

Are there examples of training innovation or best practice working with those groups in how they build those skills?

In a previous project developing skills with the ambulance service, it was the first time on the island of Ireland there were community paramedics. That was mainstreamed and scaled across the 26 counties in the South. It had never been done before it was done along the Border corridor. They had to go to Scotland first to get their training. In tandem, there was the development of a master's in paramedicine in UCC. That is one example. It was seed funding in the previous round of INTERREG VA but it is now embedded in the ambulance service in the South.

How is that captured? It is a good news story. From a funding point of view, that is exactly the sort of thing organisations want to surface in an evaluation. How is recognition given to further seed funding?

All of the projects are subject to independent evaluation at the end. It is only then that they are mainstreamed subject to positive evaluation. We have comprehensive evaluation of all of the projects because it is a requisite of the projects.

Is it possible to trace a scaled-up initiative back to where it started?

Yes.

What was done with the ambulance service here has been translated into this year's development, so we are putting in more community paramedics. The intention is to develop that. You learn from the evaluation that has been done and translate what is possible. We are developing and building it now and there has been learning as we go. There is a lot of good collaboration between the National Ambulance Service, NAS, in the South and the Northern Ireland Ambulance Service.

The source of the question is more because the all-Ireland labour market is a core focus for us. This is a practical example of how to overcome, but also learn from, that in terms of how to roll it out more broadly.

What is the general level of awareness of the programmes and offerings funded and provided among the population in the Border counties in particular? Is there work on that?

Our sense is that it is good. At the management board of CAWT, it is a very present issue in that I think there is a general sense that there is a relatively good understanding but that more needs to be done. It is an area we are looking at. I think there is a view that we probably could do more in communicating about it. As part of learning from previous years' work, we did a lot of work, as did Ms McCloskey and her team, on the launches of these. We use them as a platform not just to launch them but to broaden the communication and use them as communication opportunities. There is a sense that there is more we could do in that regard, and we will do it.

I thank the witness.

We now move into the second round with Sinn Féin. Which one of the three Deputies wants to lead? I will leave it in your own hands to pick.

Maybe I will lead as I have a specific question. I am really heartened to hear the witnesses talk about the Change Maker programme. Will Ms McIntyre just give me the amount again for the overall figure for the Change Maker programme?

It is €40 million. There is €20 million specifically looking at cross-community and new community activities that would bring the communities together. There is also €20 million specifically targeted for cross-Border activity.

How much of the €40 million has been spent? Has any of it been spent?

It has just recently opened and we have only allocated about €1 million of it so far. It is being run for us by Pobal here in the South and with support partners in Northern Ireland such as Co-operation Ireland and the East Border Region, EBR, which help to direct projects. We also got some feedback at the end of last year that it was still difficult for some projects in terms of the application form so we actually closed the programme for about two weeks and completely simplified everything. We put out all new simplified guidance. We are expecting projects of around €9 million to come in at the minute, where they have the work on the application done, that we are aware of.

That is up to €100,000. I will tell you the reason I am asking. In Mayo yesterday we had Emma Shaw from the Phoenix Education Centre in east Belfast. We met with many different groups including the education and training board, Foróige and Mindspace Mayo, and we went to the local authority as well. We are looking at projects between east Belfast and Mayo, the exchange of learning and the collaboration there, and what we can do. I know that Ms McIntyre cannot say to me that projects will be approved but would that type of project lend itself to the Change Maker programme? Could I also have an idea of the timeline from when an application is made to when an application could be approved?

I think it probably would be something that could lend itself to Change Makers, and especially if they are just starting a small project. That is usually the best way to, you know, dip their toes as such. We also fund projects that include organisations from outside the main programme area, which is Northern Ireland and the six Border counties. It is called the functional area, from an EU perspective, but it allows, for example, if a project is in Belfast and it has a natural link with somebody in Mayo or Dublin or Cork. If that is who it links with that is allowable. The Change Maker programme itself is open and is going to roll for several years. This is what we wanted and that is why we were keeping it visible. While the big projects like these have been allocated we need to see the impact of these funds on the ground.

I have a couple of questions just on that. What type of funding is allowed under that? Is there funding there for staff? What type of-----

It is generally not for staff. We would not be able to just fund a staff member. It is more about activity, or it could be research, or it could be bringing in experts to facilitate events, or just running events and taking children away for activities.

So transport could be included in it-----

Yes it can.

-----and accommodation if we were to bring groups of youngsters down to Mayo. So it could be included in that?

Yes. Absolutely.

It is really good to know that it is rolling and is not going to be something that is going to be cut off. From the time an initial application would be made for it are we talking about months? An application could be made tomorrow if the right partnerships were set up.

Yes. The call is open all the time. The applications are made, and there would be a stop on a Friday, for example. They would take the applications that are there, get them assessed, get decisions made and just keep on going. Projects can also get support to help them develop their application and see what is eligible and what should make a good application. If for any reason they were rejected they could just come back in again.

Where would they get that support from? Is it through the Special EU Programmes Body?

It is the support partners for Change Maker. Our website will have all the details on the Change Maker programme. Co-operation Ireland and East Border Region in Northern Ireland are the organisations we have appointed to help people actually make those applications. An applicant can also have as many projects as they want running at the same time for different activities, if they have the capacity as an organisation to do that.

Can that be done in any county in Ireland and in any county which wants to have a partner on each side as well-----

Yes and in Northern Ireland.

Ms McIntyre gave a figure there but how many applications are in to date from different counties?

I do not have the exact figures on that. I know they are working on it. In my last analysis, I was told they were at €9 million. These are projects where applications had been put in and which are now being reworked on the simplified costs elements. They have taken their applications out, reworked them and put them back in because they were getting a bit confused with some of the criteria. There will be €9 million then going through, we hope in the next couple of months, in terms of awards. There is plenty of money there for the next while.

Okay. That is great. I will leave my questions at that.

Okay, we will move on. Does Senator Black want to come back in? I am going down through the list as it is coming so do not worry.

I would love to know how the investment plan for PEACEPLUS was established, particularly for projects within the health and inclusive communities' team. Would that be possible so we could get some get some insights into the process? Do voluntary and community organisations, for example, play any role in that?

Yes they do. As I outlined before, just earlier in the meeting, but I will go back too if that is okay-----

I would just like to get more detail on it.

We start with the Commission objectives for the programming period, which are applied to all programmes across Europe. Then we select the ones that would be most relevant to this region. We do a socioeconomic study of Northern Ireland and the Border regions. We delve into all of those areas that we know are likely to be funded within the programme. We then speak to all the Departments North and South because every area within our programme has two Departments. In this instance, it is the Department of Health in Northern Ireland and the Department of Health in Ireland. We look at the programmes for Government in Northern Ireland and in Ireland and we start dissecting the priorities from that. The Departments then tell us what is within their priorities but which they are not going to fund because they do not have the budget for it or it is not working on a cross-Border basis. The two Departments will also look at what they could do jointly that would fit both their remits. We go out to statutory agencies and every council. We had over 400 written consultations. They come from the statutory agencies to tell us what they believe is needed. We also went out to speak to citizens and over 1,000 citizens turned up. We went to every single council area and spoke to them. They told us what they needed on the ground. Then when we took all of those salient parts and put them together and that is how we came up with the investment areas. We have to be very clear that we are not funding anything the Governments should fund. This is not replacement funding. This is additional funding specifically focused on peace building. In our view, in areas like this in particular, it is about dealing with past trauma and equality of access to services, especially for those in rural communities.

That sounds like very interesting work. I would say that Ms McIntyre really enjoys that. It is something I would absolutely love to do and go out and meet everybody. It sounds amazing.

Is the shared island unit involved? Is that part of this or is it completely separate?

That is completely separate but we would work in collaboration with it and we would stay close to what it is doing as well. We had a meeting just last week with it.

So it is linked in some way or maybe they tell each other what is going on.

It is separate but they are interlinked in certain things.

I suppose we do not want to have crossover either.

Yes.

I thank Ms McIntyre.

We will now move on to Mr. Hughes MP.

I reiterate the comments of my colleagues in the welcoming presentation on the opportunity to engage.

Our experience on this committee over the course of the past few months has demonstrated clearly there is a dire need for enhanced collaboration on healthcare across the island on a North-South basis to deal with issues like early intervention, trauma, the legacy of the conflict and public, physical and mental health provision.

Returning to the continuation of PEACEPLUS funding, there is an absolute need for the continuation of the programme, including, crucially, a contribution from Brussels. I worked in the European Parliament during the Brexit saga and in the first tranche of negotiations on the multi-annual financial framework Irish MEPs worked very well together and with others to guarantee the continuation of PEACE funding through that process. It is essential it is maintained. It is an important avenue that must be maximised and accessible to those who need it. Brussels's contribution to that is both financially and symbolically significant. It is an investment in the North. What does it say about the trajectory of the European establishment at this moment in time that it is pursuing an agenda of militarisation while potentially cutting funds to PEACE projects? I commend, as others have done, the work of Kathleen Funchion MEP, Lynn Boylan MEP and other Irish MEPs who have brought this to the fore.

We have to be conscious when discussing this that the North is a unique place within the European framework. Everybody born in the North of Ireland is entitled to Irish citizenship and by extension EU citizenship. In addition, we have the April 2017 Council statement that says quite clearly that in the event of Irish unity the entire island automatically rejoins the European Union. That is something that was not presented to our friends in Scotland or our friends in Catalonia when they pursued independence, so the EU must look at investment and funding in the North exclusively as an investment and not as a cost. I am curious to know if there is anything more the witnesses think we could do on that issue. Would it be worth this committee writing to the Cypriot Presidency of the EU to reiterate the need for that Brussels contribution to continue, and to continue uncut?

Mr. Healy addressed Senator Murphy's comments on potential obstacles and in doing so he referenced the potential avenues for additional co-operation and collaboration into the future. If he could give us a few examples of those they would be most welcome. To carry on from the comments by Senators Black and Stephenson about the diversity of issues that can be addressed by CAWT or PEACE funding, is there a review mechanism or an instrument to change the agreed areas of collaboration? I am conscious that PEACE programmes last quite a long time and public and health issues can evolve throughout the funding periods. Is there a mechanism to inject priorities or reduce them as and when the demand is required?

The projects that are prioritised now are prioritised and we will be continuing with those. Maybe I am not picking Mr. Hughes up right but the intention is to see these through and it will require the full period to do that, so we will not be reprioritising the ones we have already approved and projected, if that is what he means.

It is more to address evolving trends. Senator Stephenson referenced ending domestic and gender-based violence and Senator Black mentioned addiction services. As the public health demand on an issue grows is there scope within the programme to adjust priority or put a focus on something that is emerging as an issue, rather than waiting for the project cycle to end and recommence?

I will talk about it from a programme perspective rather than the specific projects because obviously the project has the funding within which to deliver the outputs and results it said it would. We consistently look at emerging priorities throughout the time span. When the programme was approved back in 2023 we knew certain funding calls would not come out for maybe another year or so. The programme had been written for a year or more at that stage as well. We always said that whenever it came time for the call the two Government Departments would also help us address what was a priority at that time because it could be a year later. As such, those calls have been updated. We continually look to see where we can modify things. As I mentioned earlier, we are going with the Change Makers. We are actually addressing violence against women and girls. We are looking at the new communities. If we identify any other gaps in the area we will put out a call for those.

On Mr. Hughes's comment on the PEACE programme, I can only say I fully agree. The committee would expect nothing else. I would be more than happy if we adopted a pincer movement and got all the support we possibly could, which might be the committee writing to the Cypriot Presidency. We will also be running awareness sessions to raise awareness for the people who maybe hear of the programme but do not know exactly what we do. There will be an event in Brussels and an event in Dublin and I hope the members will all come. We will send invitations. There will be one in London and in Belfast as well. That is about raising the profile of the programme.

Wider than this particular PEACEPLUS programme we also look at new areas of interest in terms of the all-island stuff. We are looking at the moment at perinatal pathology and there is a lot of work going on. It is an area that has been identified and we are looking at how we can collaborate on that. We have talked about the ambulance service. CAWT is facilitating a process where we see how we can improve collaboration across the Border on ambulance services. Separate to that, through the management board we are scoping out a feasibility exercise on cross-Border acute services. This will be facilitated by CAWT. This is work outside the PEACEPLUS piece we would use the CAWT mechanism or the all-island mechanism to do. We have those and that enables us to look at new issues emerging or challenges we feel are there that we could plan for.

In a sentence, I would like to hear about the public manifestation of the cross-Border work on paramedic services. I represent an area under significant pressure when it comes to paramedic services for myriad reasons but what does this cross-Border work actually entail? We spoke about training and UCC but is it the interweaving of services across the Border? I am aware of the memorandum of understanding and other initiatives.

There are different rules on how drugs are handled and a whole range of things like that. How do we facilitate ambulances travelling across the Border to deal with emergencies? How do we assist both jurisdictions to enable that to happen in a more straightforward and simple way for the benefit of those living in the region, and so on. There is a range of things there. The NAS and the NIAS work very closely together. We have a mechanism there between them and CAWT will facilitate that engagement.

These issues evolve and relationships evolve as well. It reflects a previous comment by Deputy Moynihan that one of the areas we are also funding now is fire and rescue and emergency services and public health for those agencies on a cross-Border basis. They have started at the stage that maybe the ambulance service was at many years ago. They have started to look at legal and administrative obstacles and we have funded that project to address some of those and maybe put in place memorandums of understanding on how they can work on a cross-Border basis. These issues are evolving and we have space to be able to fund some of those.

We are going to finish up now, so the only person who has not had a chance is Deputy Crowe. The floor is yours, Deputy.

Thanks very much. The witnesses are all very welcome. I was the Chair of the health committee and we did a number of visits to the North. On one of those days we went to Daisy Hill. It showed the potential there. There was a theatre there that had staff but it was not being used every day of the week, or even three or four days a week. Consider the potential of that hospital, particularly given the Border context and the fact we have such long waiting lists in the South of Ireland. Would the organisations represented here highlight that during their meetings with the Department of Health?

Maybe there is something in the South of Ireland that might be of interest to the trusts or whatever else. Is that one of the things, and how does that structure work?

We came back and we put it into the system and, basically, as far as I know, nothing has happened since. I accept all these things take time. Does Mr. Healy see that as an essential part of his work?

Absolutely. It speaks to what I was saying earlier around the new system that is there now with the six regional executive officers, REOs, in the South and the CEOs in the North and the processes that we have there. Sara Long, who is the REO in HSE Dublin and North East in the South, and Steve Spoerry, who is her equivalent in Northern Ireland, are already working closely together. There is collaboration around Daisy Hill. There is a dental initiative that will be starting shortly but that is just one. They are looking at working closely and at how those opportunities the Deputy talks about in relation to Daisy Hill or the equivalent in the South, can be utilised. It goes back to what I was saying earlier, that I see real opportunities in the process and that interconnection now, and the work between the HSE and its equivalents in Northern Ireland with the trusts. Daisy Hill is one but also Ms Long is connecting with Belfast, etc. There are opportunities and real initiatives already under way. Ms McCloskey is sitting on that crew because Co-operation and Working Together, CAWT, is facilitating some of the engagement there and we can use these mechanisms to do that. They are opportunities that will grow and develop as the services collaborate to a greater extent.

It would be useful at some stage - maybe not today because we probably do not have the time - if we got an idea of whatever that structure is. It can built on because it makes sense. It ties in.

It is learning from CAWT. It is not about big organisational structures but rather partnership arrangements. We are just working now collaboratively as senior executives in the South with the senior executives in the North. We meet in a structured way and an engaged way but you do not have to establish any big structure to support that. We use the existing arrangements from CAWT and otherwise to try to do that. That is the kind of way that it works.

You need it on your agenda, whether it is North or South. When those key people are meeting, that is part of the job.

The other thing I was going to ask about is the PEACEPLUS funding. It is so important. Everyone we talk to says how vital it has been, that it needs to continue and that, hopefully, that will happen. I was listening to what was said about who makes the decision regarding the division of the PEACEPLUS funding. I am looking at the papers on PEACEPLUS at a glance. For example, shared learning is investing in young people. It received €51.3 million. The PEACEPLUS youth programme received €47 million and youth mental health received €25 million. Then there are the other ones in relation to supporting sustainable development. It lists the funding there. Health inclusive communities and collaborate health received €97 million. Rural regeneration and social inclusion received €50 million. Victims and survivors received €25 million. Who makes those decisions in relation to where the allocation of that funding goes? I heard what was said about it being collaborative and that they have meetings, etc., but how to do they come to this conclusion? I suppose that is one of the questions that a lot of the groupings that we are meeting ask.

I welcome what was said about trying to simplify the process because that was what a lot of the groups we met said. In our last visit to Belfast, that was the feedback we were getting. They said the structure needed to be either supported or changed. For instance, in the South, when clubs would be looking for the sports capital grant, the local authority would have a structure there or someone with expertise, etc. I asked if there is any structure like that and they said, "Not really." Maybe that is something they could look at as they move forward.

What I would say in relation to the allocation of the budget is that we identify all of the areas of need into the investment areas and themes and that is based on all of the analysis that I outlined earlier. On how we allocate the budget, truth be told, we do the allocation of the themes and the budget. Normally, that is based on past experience from the size of projects and the cost of projects currently. For example, with the capital projects, we know that the cost of a capital project would be certain amount on average. We have to verify to the Commission all of the budgets and the outputs and they have to add up in relation to a certain number of people. In terms of young people, we know that the cost of a young person being in training and being looked after in a programme is €5,000. We work it on the basis of budgets and outputs, and also project pipelines - what we know can be delivered.

There are some areas in the programme that we could have spent far more money on and we got far more applications than we had money for and then there would be other areas in the programme that maybe were a bit slower in giving us the applications that we needed. We have to work on what we know we can fund, what is going to deliver the outputs and what is going to be able to be evaluated. That is our decision. Once all of that is done - we work in close collaboration with the Northern Ireland Executive and the Oireachtas - they have to approve the programme as drafted. The finance Ministers would keep a keen and close eye on where the budgets are going.

In relation to the local authorities, we have always said we put in the Change Maker funds to have simplified application and grants for smaller community projects which do not have the experience or the capacity but the local authorities all have to deliver. We give the local authorities an allocation based on deprivation index and their need. We tell them what areas to fund. They are supposed to make sure that they are funding the local groups. The local groups may have to tender. As the Deputy will be aware, they cannot be allocated the services directly. They might have to tender. They may not have been successful or they may not have been able to do that but the local authorities have that money for their local areas for building positive relations, local regeneration and inclusion, and expression of cultural identity and inclusion of all citizens.

Is there support from the local authorities, for instance, for youth organisations?

There should be because we are funding them to do that work. You could have a local authority which has developed a plan, which we then look at and say that it meets the objectives, that it has brought 20,000 people together or whatever the results may be. They are funded to do that work and they should be doing that work.

I was going to ask Ms McIntyre about horizontal principles but I will not get into that today.

I thank Deputy Crowe. Every member has had a contribution. I thank them all for coming in this morning. The questions and answers were very good. As a Border dweller, CAWT has been coming across my desk for the past 20 years. The core purpose of CAWT is to enhance the health and well-being of people living in the Border region by improving access to health and social care services in the Border communities. To achieve this, CAWT partners work collaboratively to identify, develop and deliver innovative cross-Border services and projects that bring tangible benefits to the populations we serve. It is not all the bells and whistles in health services that CAWT delivers. It is the small targeted things that it delivers.

In Monaghan, different services were brought in on a cross-Border basis. Only for CAWT and the €116 million - approximately €3.75 million a year for the last 30 years - a lot of services would not be there.

As was said, services were pioneered in the Border region and then rolled out nationally because the health services on both sides saw what could be delivered. We have 100,000 patients, clients or whatever you want to call them treated in the Border regions.

Moreover, 40,000 people received training in different areas, along with 700 staff. It has been a success. It is delivered on the ground in small ways in small communities. That is what it is all about. We can all have the big, overarching, glossy healthcare services - they are needed, there is no doubt - but I often saw what CAWT did when I was a councillor. You saw memos or things coming across in the council about health services. Some services were brought into places like Monaghan especially and you might not have known that service was needed here. Well done to CAWT and I wish it all the best going forward because it has proven to be a very vital service in the Border region for health services. To all the witnesses here and to all of CAWT's staff, I thank them very much.

Before we finish, there was a suggestion that we write to the Commission as a committee. I think it is a good idea. We might leave it until the private session. Today, we are saying it is a positive idea and we should do it.

We are carrying out a report on cross-Border health so this has been a very valuable interaction.

We should put whatever pressure we can put on whatever organisation of which we are part.

I thank everyone for being here and for travelling. I wish everyone a safe journey home.