Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

It is also important to take a global perspective and recognise there are many nurses coming to Ireland at the expense of their home countries. I am thinking of the Philippines in particular, which trains 13,000 nurses a year, 10,000 of whom leave to go to different parts of the world. At the World Health Assembly, I sat with the Filipino minister to recognise that. We are doing a lot of work to try to support those nurses and their families and to have that circular training. It is not just about us taking from other countries. We have an obligation to make sure that we are not doing that at the expense of other populations around the world, and we are quite conscious of that.

With regard to the NTPF and insourcing, this is one of the most important pieces of work, first, because of the proper processes involved in it, second, to ensure there is no corruption of those processes and, third, to ensure it is not operating as a barrier to us getting to a universal public system. I became aware and concerned about this at an early stage, some six or eight weeks into being Minister. It arose from constantly asking about the use of CT machines and diagnostics. I would ask what time a CT machine runs until and be told that it runs all night, but not whether that is for emergency or elective procedures, or what happens on a Saturday. In a hospital, I would hear that the MRI machine does not work on Saturdays. I wanted to know why it did not work on Saturdays and whether it was because, say, it needed a rest. It turns out that the machines are working in some of the hospitals but they are not necessarily working in the public system.

What are the constructs behind that? This is not to say they are not legitimate or that they have not been developed with knowledge and purpose, because they have. They have been developed for the purposes of trying to meet patient need and reducing waiting times for people who need surgeries and diagnostics and who have painful conditions. Our difficulty is that until we have the insourcing review that Mr. Gloster has completed, we will not have a real understanding of what is happening on a site-by-site basis, what the national implications of that are, how that is being used in different ways and how that has the capacity to be used wrongly, in my view, even if legitimately, but wrongly in delivering the overall public good of a public system working at maximum productivity.

We will come back to the question of primary care centres. I will ask Mr. Tierney to comment.