Mr. John Hennessy:

It will be earlier this year anyway. It will give us an opportunity to take a careful look at what is counted and reported, and at how performance is measured within the system. There is a balance to be struck between asking people to count, report and spend their time compiling data and asking them to treat patients and deal with their priorities. There is a role for technology in this respect. It is clear to me and others that what we have at the moment is not an accurate or comprehensive reflection of the scale and scope of what is carried on in the school health programme. I would like to make it more robust by adding some qualitative metrics to the crude number-crunching and number-counting that is taking place at present. It is easy to say that, but it is more difficult to do it. Somebody has to compile it and prepare the statistics. There is a fine balance between deploying staff to do that and deploying them to deliver front-line care. We have to strike that balance. I acknowledge that we need to demonstrate performance and activity in a much more effective way than we are doing at present. I hope to make inroads in that regard in the 2014 plan. This process will involve engagement with the stakeholders in the system, including the institute and our own staff internally.

I would like to respond to the important points made about the child health record. It is a huge opportunity for parents to own and hold the child health record for their child. It is probably the most appropriate and safest place for that record to be held. I see an opportunity to expand on those pilot areas. I am conscious that if this were easy, it would already be done. Obviously, there are difficulties. A number of technology issues are probably associated with the extension of this. I am happy to explore it further

The critical question of access to services for minority groups and disadvantaged groups arises in particular in the context of the issues of health care outcomes and equity and fairness in the system. I will ask Ms Queally to tackle that issue and make some comments on this critical area. The achievement of outcome equity as well as access equity is an important objective. This means focusing on disadvantaged groups in the design of health care systems. I am aware of a number of pilot projects around the country that aim to address this issue by examining how the design and delivery of the service can suit the needs of particular groups, as opposed to the vast majority. I am well aware that Travellers, for example, can fall through the gaps in the generic delivery system. Ms Queally might comment a little more on that.

One of the future primary care priorities is to ensure primary care becomes a far more productive part of the bigger health system. For practical purposes, that means moving an awful lot of activity that is currently conducted in hospitals out of that environment and into primary care centres. I am particularly focusing on areas of diagnostics, particularly primary diagnostics such as ultrasound and endoscopy. There is also a focus at the other end of the spectrum on chronic illness. Significant amounts of activity in both areas can be conducted safely and appropriately in primary care settings. It is pretty inevitable that this will increase the workload. It is more appropriate. In the future, it could determine whether hospitals and community settings work effectively and productively. The objective of the exercise, as far as I am concerned as the incoming director of primary care, is to reduce the number of routine patients who turn up in acute hospitals every day and every week and transfer that activity to primary care.

I acknowledge the good experience mentioned by Deputy Regina Doherty. It is good to hear that she has availed of our modernised public health nursing service. I appreciate her concern, which is shared widely, that the children and family agency may become a child protection agency only. I acknowledge the concern that the public health nursing service may engender fear in households rather than receiving a supportive reception. It is a hugely important point. I will have to discuss it with my colleagues in the new department and in the HSE. We have to ensure we avoid that risk. I would see it as a retrograde step. I note the Deputy's concern about this critical issue.

Before I ask Ms Queally to speak about equity in the system and Dr. Shannon to take on the questions about obesity, it is worth repeating that the HSE and the institute have shared objectives in respect of a number of issues that have been raised today. It is useful for us to explore the model of public health nursing and service delivery. It is pretty clear to me that we have a shared objective in improving the health of children. Major emerging issues such as obesity have been raised. It is important for us to get good value for money. The public health nursing service is an expensive service but it is also a well-qualified, well-trained and well-focused service. It is important for us to get good value and good productivity from the resource and a good return on the investment. I will not make any excuses in that regard. This will be a priority for me. It is also hugely important for us to get consistency across the country. It is fine to have good pilot projects and models in certain areas, but we need to ensure that is applied consistently across the country. Likewise, we need to achieve fairness in the system in terms of equitable access and equitable outcomes from the input of the entire health service but particularly the public health nursing service.