Róisín Shortall (Dublin North West, Social Democrats)
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Everyone is very welcome. I note the impressive progress made with the enhanced community care programme. It is fantastic news. People sometimes concentrate on the impact that has on the system, which is a no-brainer in terms of taking pressure off the hospitals, but the more important thing is the impact it has on patients in that they get local care and access to earlier care. From a system point of view, it is a no-brainer because it is better value for money as well. Let us hope there is continued acceleration of that programme.

In response to the last point that was raised on the shortage of GPs, that is the reality. People have no where else to go other than emergency departments, EDs, very often at nighttime and during the night. For that reason, I cannot understand why we have not introduced salaried GPs. That has to happen. Mr. Watt spoke about the reality of the interests within the health service. Particular interests should not be controlling progress within the health service. We need salaried GPs to do the work out of hours. We should not be expecting people who are running services during the day to do out-of-hours work on an ad hocbasis, and that is the way it is working at the moment. If we had salaried GPs, we could have those primary care services open around the clock. I believe there is much interest from people in the flexibility that a salaried GP part time, four days a week, four evenings a week or whatever would offer. I urge the witnesses to move forward on that.

Related to that is the major problem of the lack of coherent workforce planning. We have been raising that at this committee for the past three-plus years. At the moment, we are in a situation where there is money provided for services but we cannot get the staff. It is a major block on providing an adequate and functioning public health service. Who is responsible for workforce planning in the health sector? Is it the Department or the HSE? Why do we not have a workforce planning function within either institution? It is a major area. It should not be an afterthought or given to somebody who is already doing other work. There are all of those elements. There are the projections, first of all, and there is the work on the figures. We have the census figures now. There are the third level places, the clinical placements and the key thing of recruitment and retention. We are training many people but the problem is we cannot hold onto them. There are possibly a number of elements to that, such as the housing problem, but there is also the dysfunction within the health service that drives people out. Nobody seems to be asking why so many people are leaving in droves. Who is responsible and why do we not have a workforce planning function?