Louise O'Reilly (Dublin Fingal, Sinn Fein)
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Good morning and happy Valentine's Day to everyone. I want to address a few issues, the first of which is workforce planning. Similarly to Deputy O'Connell and others here, I was a member of the Committee on the Future of Healthcare. Workforce planning formed a considerable part of our discussions. Looking at the future, we have general practitioner, GP, practices that are full. In Fingal, we have the youngest and fastest-growing population in the State. There are now GP practices that are full for kids, which is causing a huge problem. On workforce planning, while serving on the Committee on the Future of Healthcare, it became apparent that workforce planning was not something the HSE was on top of. I had experience of workforce planning units being disbanded and people being moved to other duties when staffing levels were cut. The witnesses might be able to comment on what we need to do with regard to workforce planning. It strikes me that we may not be prepared. We seem to arrive at situations that are very easy to plan for, especially relating to the age of the population, which is probably one of the easiest things to plan for, before even considering illness profiles, yet successive Ministers seem to be shocked that people get older as the days go by. The witnesses might enlighten us as to what we could recommend for workforce planning.

On practice nurses, the unsung heroes of the GP world, do the witnesses see scope for practice nurses being able to expand their role? Will they comment on the method for payment? Some GPs have said to me that the mechanism by which one runs a GP practice, which will bring me to my next point, is quite cumbersome and complicated. There is a huge amount of paperwork. Can we fix that by simply putting in place salaried GPs alongside salaried allied health professionals and salaried nurses working directly for the HSE? Would the witnesses see it only as a model whereby salaried GPs would be there for the start of their career but would then move into their own practice - entrepreneurial was the word used - and run that? Do the witnesses have specific recommendations about the expanded role for the practice nurse with regard to what the nurse could be doing? We have had the Irish Nurses and Midwives Organisation, INMO, and SIPTU, here on several occasions. They are never shy about saying that their members are up for change and embracing new roles. There are obviously industrial relations issues that will arise from that but there does not seem to be unwillingness on the part of nurses to take on an expanded role. Do the witnesses see that as part of future expansion?

I have questions about IT equipment, specifically the availability of diagnostics. The average person would say that if there was a scanner in the doctor's surgery, he or she would not have to go to hospital and that would be marvellous. What type of equipment are we looking at putting into GP surgeries to facilitate hospital avoidance? It does not seem sensible for one to have to go to a GP to be told by the GP to go to hospital to get a scan. There obviously cannot be an MRI machine in every GP surgery but is there some scope there? I had discussions with companies involved in equipment for near-patient testing, infection control and so on, so that people are not sent to hospital.

On e-health and hospital referrals, if one goes out to Merrion Square, one will see women coming out of Holles Street hospital with big paper files. If one talks to people, particularly those involved in the health area, from anywhere outside of the State, they would be shocked at how dependent we are on paper files. It strikes me that there is not a huge focus by the Department on rolling out the e-health strategy. I know that one key member of staff was lost to that project. What will it take to get us to the level where we can see the elimination of as much paper as is reasonable and practical?