Ms Phil Ní Sheaghdha:

I thank Deputy Shortall for her question on public health nursing. The capacity report recommended that we increase the number of public health nurses by 700. We are going backwards. We have 40 fewer public health nurses now compared with December 2019. We need to increase the training places and we need to greatly improve the circumstances of employment. Community general nurses are supporting public health nurses in the community. As I said, they do not have a facility for waiting lists but they tell us. For example, they have responsibility from a new mother coming home with a baby, where they will make the first visit and undertake domiciliary care for a few weeks where they go into the home and provide the care. They do the same for those who require palliative care, who have chronic disease and require management in the home, and they also run immunisation clinics and so on. They have a very wide job description.

We are not training them in sufficient numbers. Something we could do quickly would be to expand the training places. There are 13 institutes of education in Ireland that provide undergraduate training but only four areas that provide public health nurse training. Because it is a postgraduate qualification, people are established where they work. There should be encouragement for people to go to their nearest educational institution and where they would be provided with postgraduate public health nursing education in all the 13 institutes of education, as well as undergraduate training. That is something that is sensible and could be done quickly.

We should also encourage those who wish to access public health training. We need to give them a break so that for those who have worked in the community and are familiar with how the community works, the time required on the public health nursing higher diploma would be reduced. These are two small things that we think would assist immediately in increasing the numbers working in those categories.

Ms Clyne and others might also want to comment on structures. We are being told that the HSE is restructuring the community. Various committees are looking at how the community will be structures from the perspective of management and governance. It is interesting that nursing is not being consulted largely in that. Public health nurses and nurses who work in the community have made a massive contribution and will continue to do so. We need to seriously look at how we align the managerial function and the community with the clinical responsibility and advice. We saw it during the pandemic when we saw public health nurses coming to the fore -----