Mr. Paul Bell:

I will be brief. It is unfortunate that Deputy Kelleher had to excuse himself because I want to touch on private sector involvement. It is not an ideological position. Much of what is happening with regard to privatisation is reactionary because we could not recruit people in the various skill sets and because there was a head count moratorium. For instance, the issue of agency staff is reactionary. This year, over €330 million will be spent by the Health Service Executive on agency staff including nursing professionals, medical professionals and, as mentioned earlier, non-medical personnel. That is reactionary; it is not value for money.

Deputy Louise O'Reilly referred to the ambulance service. An element of the private sector is taking advantage of the chaos the national health service has to respond to in order to provide services while somebody else is keeping an eye on the books and saying we did not have to recruit those people to provide that service.

Deputy Harty asked about demarcation and so forth. We have people in the community who want to do more. For instance, he referred to home care packages. We have people providing home help services. That is sometimes described in the community as a cottage industry. It is not. We have personnel who are described as non-medical people providing key services and supporting their professional colleagues, and our members want to be placed in a position where they can do more.

The other area is health care assistants. The health care assistant groups and the multi-task attendant groups want to be allowed to do more and develop their role in support of the nursing professionals, doctors and other allied health professional groups. Those are the key issues we believe we can address.

Deputy Buckley asked about the one action we can take now. Everyone in this room understands there is a massive issue about the care of the elderly. It is as if we are drifting from crisis to crisis in that regard. Obviously, value for money for the taxpayer does not mean the services are surrendered to other groups that say they can provide services, which they cannot provide. There has to be a clear understanding that the public health service must be the lead care provider. Following that, if there is ancillary work or additional work, a discussion can take place on where that fits in because at present it is reactionary.

We need to stop the reactionary issues with regard to deployment, recruitment and retention of staff. That can be done. In terms of the €330 million bill for agency staff, that can be stopped by immediately adopting a plan to invest in the training of not just professional staff but also the group the Deputy referred to as non-medical staff.

At present, the HSE is paying for almost 900 whole-time equivalents in the health care assistant grade, which amounts to between €60 million and €65 million. That is not good value for money or a good investment. Members of the ambulance service have had to threaten industrial action in recent times for the HSE and the Department of Health to invest in their service. In other words, investment is required over the incremental period of the next three to five years to bring it to a level where it can respond to the growing needs of communities.

The focus must be on investment in the care of the elderly and in care in the community, as well as in those services and people who support that. The general secretary, Ms Patricia King, has made it quite clear that there is no silver bullet for this stuff. If a ten-year plan is adopted by the Oireachtas it must include the understanding that every cent available from the public purse must be invested in a public health service that can deliver over that period. Short-term solutions will not work for us. That has been proven by our neighbours in the United Kingdom. All the short-term, reactionary responses to long-term issues end up failing, costing more money in terms of value for money and losing staff. The National Health Service, NHS, in the UK is still short of nursing professionals. It continues to come to this country to try to recruit nursing and other medical professionals.