Ms Phil Ní Sheaghdha:

Education is piecemeal. The Chairman is correct that it is not supported. We have best practice that states advanced nurse practitioners should make up 2% of the overall workforce. This would require us to have 700 advanced nurse practitioners, of which we have approximately 247. These nurses can provide services that have proved to reduce waiting times in emergency departments and the need to admit. When advanced nurse practitioners work in emergency departments they reduce the length of time patients wait and can assist in getting the patient home as opposed to being admitted. Likewise, in all other services where they work, and international studies demonstrate this, they improve the patient's journey considerably and they provide a very safe service. Unfortunately, in this country we have had a real problem in getting the Government to fund places for advanced nurse practitioners to the point that we are still well below the recommended 700 mark for these grades.

We have met the leads on Sláintecare who accept that advanced nurse practitioners add to the efficient use of bed time. They also accept that advanced nurse practitioners can and should be extended more broadly into community services. There is an idea that management of chronic disease in the community should not be led by advanced nurse practitioners but everybody knows they have a great deal to add. The same applies with regard to clinical nurse specialists. However, this requires investment in educating nurses and midwives to these levels. That would give us a service that actually has a chance of delivering primary care in the community in a very safe manner and in remote areas where advanced nurse practitioners could lead services. We can have nursing-led services in these areas. The plan needs to be approved, the availability of education needs to be fast-tracked and we need to look at models of healthcare delivery that are not solely based on the medical model. Advanced nurse practice and clinical nurse specialism are well established but they need to be funded.