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

I thank the witnesses for their presentations. It is very hard to comprehend a situation where the State is spending €23 billion on the health service and we find ourselves year on year with money allocated for different services and the HSE incapable of recruiting people because there has been little or no forward planning in relation to workforce. It beggars belief that given the level of unmet need in the country, our biggest problem in the health service is that we cannot get staff. We are talking about international recruitment but there are ethical issues around international recruitment. There is also the madness in what is happening with hospital doctors, where at huge expense we are training them to leave this country, and then trying to scramble around to get foreign doctors to keep our service together. One has to ask why there is not a clear, robust workforce plan for this year, for the next five to ten years and a plan for the next 20 to 30 years. All of these projections are available in terms of population growth, the kind of numbers that will be needed across health and social care. Why is that not being done and who is responsible for not doing it? That is the question. It is the most fundamental thing you would have in a major organisation with that kind of massive budget. I just cannot get my head around it. Why is it not happening? We have heard comments about how we have succeeded in getting an extra 60 medical places. This should not be a concession. We have succeeded in getting some extra places but it is not anything like enough. That is paraphrasing what has been said by Mr. Watt. Why is it not enough? Why have we not got the figures set out over the next 20 to 30 years?

I spoke to the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, about this, because I am gobsmacked at the extent to which our health service is not functioning and so many members of the public are denied access to essential health and social care because of the failure to plan. He said he is more than happy to extend the number of places in third level colleges if he gets some figures from the Department or the HSE. There are four key areas that need attention and we should be able to set down on paper what the needs are and what the plan is to ensure adequate numbers of staff over the coming years. I do not think such a plan exists. There is no evidence of it, and I have to ask why that is the case. In any major organisation recruitment, forward planning and doing the projections is just basic work.

The first issue is the adequacy of the number of third level places. This is a matter of doing sums and working out what numbers of different categories of staff will be needed over the coming years. There is then the question of work placements and I would like Mr. Reid to address that issue in particular, because my understanding of the situation is that for healthcare staff work placements are absolutely critical.

They are a major part of the whole training process. My understanding is that, within the HSE, the number of placements has been reduced substantially in recent years. That is causing part of the logjam. Clearly, not much attention is being paid to the work experience of people in the health service, where, for example, junior hospital doctors are leaving this country in droves. GPs cannot set up in practice because they do not have the money behind them, and we were promised salaried GPs. We also know that many people right across the health service do not have very good experiences of working within the HSE and prefer to go to other places where there are functioning health services.

The other issue that needs to be addressed is CORU; I think CORU has to be seen as part of the problem. Why is it taking so long to recognise people's qualifications? There is a whole area there that seems to have been completely neglected in recent years.

There was a time when doctors were seen to be the only people in the health service and should be the key decision makers. They certainly were in a very prominent position in the Department of Health. There was an extraordinary reverence towards them. About ten years ago, there was finally recognition of the important role of nursing and the Chief Nursing Officer was appointed on a par with the Chief Medical Officer. That was a very important development. We know that nurses should be on a par with doctors.

There is another area of staff, health and social care professionals, to which I would ask Mr. Watt to give serious consideration. These are essential people within the health service, especially as we move to implement Sláintecare and a different model of care within the community. There are major shortages of health and social care workers. Some of that has been referred to already, where money was provided in recent years for mental health services and disability services. It is a joke that the money is there and we cannot get the people. I would put it to Mr. Watt that consideration should be given to appointing a chief officer for health and social care professionals, to bring them on a par with nursing and medical professionals. This is going to be a huge area that needs to grow substantially if we are serious about patient-centred care. Has Mr. Watt given consideration to the appointment of such an officer at senior management level within his Department?

I want both organisations to respond to this point. Both organisations, and I would also include the Department of Further and Higher Education, Research, Innovation and Science, should be on top of this issue. They should have very clear plans for training places, placements, all of those things, and ensuring that when people are working in the service, they are treated properly, so we do not have a situation like what is happening with junior doctors. Why is this not happening? Can both organisations provide an explanation as to why it is not happening? Are there plans to put in place a proper workforce plan?