Mr. Francis Chance:

I will take the first and the third question, and I will let my colleague, Dr. O'Dwyer, to pick on the childcare services question. On the first area of Sláintecare, the great strength of Sláintecare is that it is an inter-party agreement on what our health service should look like. Over the last 50 years, since the introduction of the Health Act, we have been restructuring our health service repeatedly, and the health service has gone through a flavour of the current Government approach in terms of constant change. If you are talking about major systems changes within our health service, you need a ten to 20 year strategy, and that can only happen if you have political consensus on that, and the great strength of Sláintecare is that is what it achieved. However, the most recent statements on Sláintecare would indicate that breadth and that vision of Sláintecare is being lost at the moment. The slogan adopted by Sláintecare was "Right Care, Right Place, Right Time" and that is really important in terms of prevention and early intervention. Right care is about providing preventative services. Preventative services will not always succeed, but on many occasions they will. Where they do not succeed, then the earliest possible intervention is required. We should not wait until the problem gets bad enough that intervention is required, which so often happens. The right place is in the community, and ideally even in the family home with home visiting programmes. The right time is as early as possible.

In terms of the current statements made about Sláintecare, my concern is that it is all the right structure. The belief seems to be that if we get the structure right, the other things will follow. We have 50 years of history that show us that has not happened. We need to go back to the original Sláintecare vision, engage with that and move forward on all fronts and in an integrated way.

One of the key areas of Sláintecare would be the investment in child health. The particular suggestion within Sláintecare is about public health nurses. At the moment a public health nurse is responsible for everybody in his or her catchment area from birth until death. It is a cradle-to-grave service which attempts to be all things to all people. We strongly agree with both Sláintecare and First 5 that the time for that approach is long gone. We need a more specialised approach. Older life and end-of-life care need a specialist approach. Equally children and families need a specialist approach. There is a very clear recommendation in both Sláintecare and First 5 that we should have a cohort of public health nurses who are responsible only for the children and families of their catchment area. That is going to provide a better service to those children and families and facilitate greater integration with the work of other agencies such as Tusla, with early years services and with education and other services.

I will talk a little about the national lottery suggestion. One of the key things about prevention and early intervention is that it has the potential to change costs significantly in the longer term, but for that to happen it needs to be front-loaded. The savings that you will create in prevention and early intervention take a number of years to kick in so there needs to be an early investment within that. We are pointing to three different strands within that. One is that every State agency and Government Department that impacts on the life of children and families should be required to identify what its current spend is on prevention and early intervention, and then should work with the Department of Public Expenditure and Reform to incentivise and gradually increase that spend over a ten-year period. For example, a Department or State agency might set out to transfer 2% of its crisis funding into preventative funding on a gradual, slow basis, as obviously we must meet the needs of children in crisis as well as preventing children being in crisis in the future.

The Department of Public Expenditure and Reform had a prevention and early intervention unit in the life of the last Government which has been repurposed for the life of this Government. There was much good background policy work done there and we call for that to be resumed and continued, and that Departments would have an incentive fund from which they could encourage and support Departments to make those kind of moves. There would be a fund they could draw on to support those transitions from crisis towards early intervention.

In regard to the national lottery, we recently had an opportunity to look at some work going on in Northern Ireland and how the national lottery has been used there and throughout the UK in a much more strategic and purposeful manner than we have used it here. The review of the functioning of the national lottery, which is being carried out at the moment under the Department of Public Expenditure and Reform, gives us an opportunity to consider earmarking an amount of funding from the national lottery. If we earmarked one month's income, or €21 million, to invest in prevention and early intervention services each year - once there is a proof of need, the approach is proven and, most importantly, there is a commitment from State agencies that if the approach works, they will pick up on the funding in future years - there could be a real opportunity to use the national lottery in a much more strategic and creative fashion than has the been case to date.