Mr. Bernard Gloster:

There is a lot in that. I will do the best I can to answer it. Maybe I will start with what we are doing about it, because that is the most important thing to get in.

When I last spoke to Deputy Quaide at the disability committee, I made it clear that, in respect of psychology, I had removed this year's intake into the doctoral programme in psychology from the numbers count so that services did not have to come up with a position number to underscore it. I stood over that decision. I met the heads of psychology subsequent to meeting Deputy Quaide. I confirmed that for them. They pointed out a problem in one area to me, which I resolved the same day. That is just the basic piece of taking it out of the numbers. That was the first thing.

Second, and as Deputy Quaide knows as a practising psychologist, we have thankfully grown the number of psychologists in Ireland exponentially. I am not sure whether we will ever have enough because of the way the referral pathways and demands now go.

In relation to the generality of primary care, there are two things I want to say. The Minister recently gave me approval to make a short-term intervention to try to clear some of the demand lists in some of the therapies. We are doing that this year and next year. There is an element of catch-up to that. There is an element of insourcing our own staff to do it and there is an element of using private sector demand. Just yesterday, I had a team conclude a procurement evaluation for private supplementary support for the public sector to deal with the particular issue of assessment of need and autism assessments under the disability services. Next year, we will see regions investing some of the 3,300 posts in primary care services. In the letter of determination, the Minster has placed a specific obligation on me to show a positive discrimination in favour of, and towards, community healthcare challenges, particularly people who are on waiting lists for community healthcare and primary care services. We will see primary care feature in that.

There is no current recruitment embargo. There is no current restriction on recruitment. Regions have a cap and they must live within it. It is a challenge for them, but they have to do it. There are still vacancies they can fill.

If I may say, the one part I fundamentally have an issue with is that we tend to describe primary care in terms of what it was ten years ago rather than today. We forget that a substantial body of work was taken out of primary care under the enhanced community care programme. We took out a lot of adult services for chronic disease, for integrated care and for older people. A lot of staff were invested in that, and some primary care staff applied for those. I accept there is a challenge in primary care and I think we are responding to it. It is going to take a bit of time. The jobs we "lost" were jobs we were never meant to have. The jobs or vacancies we lost on 31 December 2023 - I have repeatedly said it is very hard to trace them all - would probably be in or around the average vacancies we would have in the Irish health service on any one day, which would be about 3,000 posts. I believe that has been well compensated for since in terms of the additionality we have been given.

If anyone is on a waiting list for nine, ten or 11 years for a psychologist, we would be far better as an Irish health service writing back to that family much sooner to say this is not the service that is going to meet their need and we have to look to see if there is any alternative way we can respond to that need. I do not think someone being on a waiting list for seven years is credible.