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

I thank everyone for attending and for their presentations. It is always worthwhile hearing expert voices from outside the political system and to have an assessment of performance. It strikes me the points made about the experience during the Covid-19 pandemic are very important. The approach taken during the pandemic encapsulated the kind of principles underpinning Sláintecare. A point I sometimes make outside is that I do not think that anybody, for a moment, would have contemplated dealing with Covid-19 through a two-tier system where people could buy their way to receiving treatment for Covid-19 or access to vaccines or testing. It had to be a single-tier system. Strong lessons from that experience must be taken on board in respect of the necessity of taking a population-based approach and provision on the basis of need. Nobody would have contemplated having a situation where people with private health insurance who had Covid-19 could get quicker treatment or a ventilator faster in hospital.

As was said, the major problem is that after the main threat of Covid-19, we reverted to type and went back to a situation where people could buy their way into healthcare. This is obviously regrettable. There is no doubt, however, that there are big interests pushing private healthcare and it is very difficult to counteract these. One area I must say I am particularly concerned about now is that while, in theory, the Government is supporting expanding access to public health services, particularly at community level, the major thing holding us back is the lack of staff. We now have a situation where substantial additional money is being provided but the staff are not there. This results in the outsourcing and buying-in of services and leaving it to the private sector. We have this creeping privatisation of the health service. While, in theory, everybody signed up to developing a full universal public health service, what is actually happening in practice is this creeping privatisation. My concern is that we will get to a tipping point in this regard. At the back of all this, is the fact we have virtually no workforce planning going on at all within the health service. We have raised this issue several times at this committee. No significant workforce planning is going on.

I would like to get the views of the witnesses on this point. Where should this work be done? I know that when Sláintecare was being developed, Professor Stephen Kinsella from the University of Limerick, UL, was supposed to undertake work in this context. I do not think it was ever done. Unless we have the staff available we will not be able to expand public health services, especially at community level. I refer as well, of course, to the availability of hospital doctors, GPs and so on and so forth. What are the views of the witnesses on these aspects? Do they share this concern about the absence of workforce planning?