Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I agree with the Deputy on the tracing issue. There is a balance to be struck. The public health teams identify close contacts. If someone is designated to be a close contact, he or she will be referred for testing and be subject to a two-week period of self-restricted movement. It is inevitable that some people will know they are close contacts. Speed matters on this, as does people being tested and restricting their movements. The HSE is examining the issue. The example the Deputy gave should not be happening and I will take it up with the HSE.

There is a balance to be struck. In school settings, for example, the public health teams have been working closely with teachers and principals. I have seen a number of cases where people believed themselves to be close contacts but when the experts took a look, the close-contact number is dramatically reduced. There is a balance to be struck between speed and obvious cases where people know they are close contacts. We need to facilitate them being able to self-refer to a GP. As part of that balance, we do not want a large number of people deemed not to be a risk, at least by an expert analysis, to be included. I will certainly take up the Deputy's point.

On the question about public health nurses, the short answer is that it is being expanded. Several steps are being taken with the public health departments at the same time, one of which involves creating consultant contracts for public health doctors. There is ongoing dialogue between the public health doctors, their representative body and my Department about the process. It is essential, and the doctors have been waiting a long time for it. I intend to put it in place as quickly as possible. At the same time, we are doubling the public health workforce. There are currently 71 public health doctors and a total workforce of approximately 250, a good portion of which comprises public health nurses. In doubling the public health workforce from 250 to approximately 500, work is ongoing between my Department and the HSE to determine the best configuration of that. In line with the Deputy's point, it will examine what are the best numbers of nurses, scientists, doctors, support staff and so forth. A bunch of them will work at the Health Protection Surveillance Centre, while others will work in the various public health departments.

The question about acute beds was a good one. There is no point in us spending a great deal of money and effort putting in place acute beds, ICU beds, doctors, nurses and safe staffing levels while leaving a bottleneck at diagnostics. There are now serious bottlenecks in many parts of the country for various diagnostics. We are, therefore, approaching this in two ways. There is a long waiting list of people who need to be seen. I have created an access to care fund of several hundred million euro and a large body of work will start soon with the HSE, my Department, the National Treatment Purchase Fund, NTPF, and other stakeholders to decide how we will deal with these long waiting lists, including for diagnostics. Up to now, the NTPF has not been able to fund diagnostics, but we will change that and get access as quickly as possible for people who have been waiting a long time. The second step we are taking relates directly to the Deputy's question. As we scale up acute beds, community beds and staffing, we are scaling up diagnostics too and there is funding in the budget for that.

Turning to the Deputy's final point on the three elective hospitals, I acknowledge that he has raised this many times and is continuing to advocate hard on it. The elective hospital we have discussed previously is that in Cork. The elective hospitals oversight group, chaired by Professor Frank Keane, is developing the high-level facilities spatial brief and the order of magnitude costs, which detail the clustering of the appropriate elective activities for each of the three facilities in Dublin, Cork and Galway. This will also include an output and facility specification based on efficient and effective service delivery. The spatial brief will be important in determining what size each elective hospital will be and the numbers of operating theatres, rooms for patients, outpatient units and staff who need to be employed. This information will be contained in a preliminary business case, in line with the public spending code, and I am happy to report it is due to be completed before the end of the year.