Martin Daly (Roscommon-Galway, Fianna Fail)

I thank the Minister, Ministers of State and Department officials. I will try to do question and answer as we might get more views from them on what is happening in the health service. I am delighted the investment is increasing year on year, but I am struck by the Minister's observation that we are not getting return for our investment. A number of issues come to mind, one of which is the capacity issue. Are we growing our health service quickly enough for the growth in our population? Are we putting investment into parts of the system that cannot perform without other parts of the system being reformed? The Minister has, for example, outlined the digitalisation of our health service. If she will forgive me, I am delighted her focus is on that, but being involved in the healthcare sector for many years, I have heard this story repeatedly. I know that in the general practice setting, 98% of all GPs are fully computerised and have to be for the chronic disease management programmes. However, in our hospital sector we still have a situation where, if I do a digital referral in my surgery to a hospital, someone on the other end prints off a hard copy and walks around the hospital handing out that sheet. We have heard about this for many years. This country is one of the biggest centres of the digital economy in the world and yet we do not seem to have extrapolated that into our health service.

The next point is that we have taken on more staff and there are two issues arising. One of these is retention of Irish graduates in our system. Many stories come back about the culture. It is not simply about money but culture. Are we treating not just our medical graduates but our allied health and nursing professionals properly when they come into our system? Are they welcomed into our system? Are they facilitated in our system? The narrative coming back is that they go because they are treated better in other jurisdictions after they leave here. That is a culture issue. It is not a money issue.

I am glad the Minister referred to the NTPF. I hope there will be reform of it, given some of the issues that have arisen recently. On primary care centres, we are reliant on private public partnership. In a number of areas of the country like Ballaghaderreen, County Roscommon, and Edgeworthstown, County Westmeath, we have situations where small developers have gone out of business or have not satisfied the financial requirements after years of planning and the primary care centres have fallen through. Are we over-reliant on small developers producing these primary care centres? Should we have the HSE build these centres directly?