Colm Burke (Cork North Central, Fine Gael) | Oireachtas source

I apologise for being late, I was at another meeting. The Minister was talking about the issue of community paramedicine. I have raised this matter before and have seen no evidence of a change for the coming year. We have taken on an additional 21,500 whole-time staff in the HSE. Including part-time people and everything else, 30,000 extra people are now working in the HSE compared with five years ago. Of that, only 70 are public health nurses.

I put this question to representatives of Sláintecare who were before the committee. They were shocked that only 70 additional public health nurses have been taken on in recent years. We have gone from 1,560 public health nurses to 1,630, there or thereabouts, and I have seen no evidence that that will change. The Minister talks about community paramedicine. We need nurses in the community.

A similar situation also applies to public health doctors. I am advised that at the most recent meeting, the Department was prepared to allow only 30 people in under that category. There was no agreement over all public health doctors. It seems to be sending out the wrong messages. On the one hand, we have Sláintecare saying one thing and, on the other hand, there is a policy that allowed an increase of 20.9% across all sectors of healthcare in the past five years, including nurses, junior doctors, consultants and administrative staff, while there has been less than a 5% increase of public health nurses. Are we serious about Sláintecare or is it all bluster? I am becoming more and more convinced that a lot of it is bluster. I can see no evidence that we are recruiting people to work in the public healthcare sector. That is one issue.

The second issue I want to raise relates to cataract operations. I raised this at the previous meeting and I raise it again. The response I got from the HSE was nothing but downright appalling. All I got back was a memo defending people travelling abroad to Northern Ireland for cataract operations, without any response to the question I had raised, which was about having people examined at an early stage, put on the list for the procedure and then, if the public health sector cannot deal with doing the cataract operation, it comes in under the National Treatment Purchase Fund. There was no reply to that question. The reply I got was appalling and extremely defensive of the fact that we are sending people out of the country to have a basic operation. That really needs to be dealt with.

There is a third issue on which I wish to touch. My understanding is that there are 685 applications for GP training this year. That is the largest number ever. One in eight of our existing GPs are over 60. What can we do?

Can additional training places be provided? Obviously, that would be done with co-operation. For a GP to go into training, he or she needs a practice that is prepared to take him or her on and go through the whole programme. What discussions have been held with the Department about increasing the number of GP trainees in order that we will have enough people in three to five years' time to fill the vacancies that arise?

I wish to refer to an issue that I raised recently with Revenue. We gave a special dispensation to meat factories to bring in people to work in particular jobs and earn less than €30,000. Some of my colleagues have mentioned that we need people in the community to provide home care and everything else. A huge number of people live in the same home as those to whom they provide 24-7 care five days a week. As happens in other countries, these carers are provided with food and accommodation. However, the cost of providing accommodation and food is not taken into account by Revenue when assessing people for tax purposes. Let us say that a person wants to bring in someone from abroad who is experienced in the provision of home care and care of the elderly. The same criteria are not in place for people from abroad to come here and provide home care. Interestingly, in Israel, more than 5,000 people are allowed to enter to provide home care full-time because there are not enough people to do the work and we will face that challenge here as well. We need to provide a home care package where people call two or three times a day to different individuals. However, there are those who need permanent home care. I ask that this issue be examined.

In terms of the community healthcare issue, I am not convinced that this happens and there is no evidence to support the claim. Can the Minister indicate where in HSE budget has money been set aside to deal with this matter?