Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

The witnesses, all of whom I know, are very welcome. It is very heartening to hear ICTU's support not just as the representatives of health care professionals, but also as representatives for workers outside the health sector who depend hugely on the public health service. ICTU's support in this regard is very welcome. I am hopeful that this support might nudge some of my colleagues into being a little more vocal. We need the political will to implement Sláintecare.

We do not lack research findings and a plan. Sadly, we do lack the political will to follow through.

I welcome ICTU's statement on the incompatibility of building decent public services, including health services, with tax cuts. I am sorry that there are not more of my colleagues present to hear and understand that message.

I want to ask a few questions that I asked earlier today. The ICGP has described the terms and conditions and pay structure for practice nurses as Victorian and inflexible. I know that practice nurses are flexible. How can we ensure we are getting the best value for money? Before we adopt an expanded primary care model, we need to move forward in achieving good value for money, respecting patients and workers and building the best foundations to broaden the services provided. I asked the previous delegates to outline how money reached the GP through the operation of the small business model? How is money passed on to those who work as part of that cohort? If someone is paid on a fee per item basis, is it always paid on the assumption that it is the GP who will provide the service or are there others who can provide it? If it is the latter, how are they remunerated? Is there scope for the use of advanced nurse practitioners to form part of a primary care team?

I am sure we all agree that having primary care teams in the community is a good idea. Will the delegates outline what they consider to be a fully staffed fit for purpose primary care team? A general practitioner often leads the primary care team. What is the working relationship like between the GP and the primary care team? Do the delegates envisage a GP being the employer in an expanded service? Do they envisage the entire primary care team being employed by the one person and working together in providing an expanded service? The small business model of general practice seems to be quite limited. Such a model will not be expanded without the addition of allied health professionals and others who would form part of a primary care team.

I am a massive fan of home helps and anyone who knows me will not be surprised by my next question. Will the delegates talk about the expansion of the home help service? The committee has met representatives of home care providers and the HSE and they painted a picture that it was sometimes difficult to find home helps to work, specifically in the evenings. As a result, people were forced to access services from the private sector. I doubt if much has changed since the last time I represented them, but I have always found the home help service to be one of the most flexible and responsive in the HSE. According to the Department of Public Expenditure and Reform, the average cost of a home help is €24.20 an hour. Some global multinationals charge up to €42 an hour. In the context of an expanded service and what constitutes value for money which is always paramount, will the delegates comment on from where the figure of €42 an hour stems. Is the service capable of being expanded? I believe it is; therefore, it is unnecessary to source home helps from multinational corporations. Many of the independent and directly employed home helps are capable of providing the service. Will the delegates confirm that for us?