Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I thank the witnesses for all their ongoing work. I want to pay tribute to Ms O'Connor. I have known her for many years, both locally on the northside of Dublin and at a national level, and her service has been exemplary.

She has provided outstanding leadership within the public health service and she will be a huge loss to it. I wish her well in her new career and thank her for all her work. I also wish Mr. Liam Woods well in his new role. I am sure we will be engaging on that shortly.

There has been a fair amount of talk about what happened during Covid. The HSE showed its best side during Covid in terms of how it as an organisation and all of the staff responded. Everybody adopted a shoulder-to-the-wheel approach which was outstanding across the board at all levels within the HSE. Two key principles were followed during Covid. The first was that we effectively had a single-tier health service for a long period during those two years. That made a huge difference. The second was that services were available free at the point of use. I have thought about this quite a bit since. Let us imagine a situation where the Government or HSE decided that people would have to pay for vaccines. It is unthinkable that only those who could afford it would be vaccinated. That would be a two-tier system. Let us imagine that only people who could afford to do so could take Covid tests. There are people who had multiple tests. That is also an unthinkable scenario. The principles underpinning Sláintecare are to have a single-tier health service that is free at the point of use. We saw those principles in action and how well they worked. The concern is that we are now moving way from that. Thankfully, we are moving away from the particular pressures of Covid - the big ones at any rate. Given that we would not for one moment think of doing things differently during Covid, why are we reverting to a two-tier system in which money talks and it is tough luck for those who cannot afford it? We need to preserve the lessons learned from Covid about those things that worked very well.

I will not go into individual services, as we normally do with the service plan. There are many issues we could ask about in relation to staff, waiting lists, etc. There are common themes running through the problems in the health service and we need to look at some of those overarching themes.

On Sláintecare, I sometimes get the impression that Sláintecare is in one place but the real day-to-day health service is somewhere else. The Sláintecare stuff is theoretical and many of the elements of that are not being implemented. There are reasons for that. The difficulty in recruitment and retention is a major stumbling block to implementing Sláintecare. I am also concerned about the talk of a ten-year implementation plan. We are halfway into that. It is not an implementation plan that achieves implementation in ten years but a staged plan. Notwithstanding Covid, a great deal of time has been lost in terms of that implementation plan. I am not saying that is the fault of the HSE. This has to come from Government, as it must provide the funding and policy direction.

The overarching issues are principally to do with recruitment and retention. Why are those problems there? Why is it so hard to hold on to people and to get people in the first place? This can be a self-fulfilling prophecy because the more people leave and the more vacancies there are, the harder it is to stay because of the increased stress levels. We have seen a large number of people leaving. One has to ask whether there is a cultural problem. I am not sure what the answer is and what solutions the HSE is bringing forward to address the critical problems of recruitment and retention. Will Mr. Reid talk to us about that?