Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I welcome this opportunity for statements on Sláintecare. I do not know why it was not entitled Sláintecare and I do not know why the Sinn Féin health spokesperson is trying to rebrand Sláintecare. Its strength is that it is an all-party policy. That is what gives it real effect. I think we should stick with that and be at one with regard to what we are trying to achieve in this country. I also welcome the progress that has been made in implementing Sláintecare. We have not progressed to the extent we should have. This year, part of that is certainly because of the inadequate budget. I have to say that it is the key responsibility of a Minister and his or her Secretary General to run a strong pre-budget campaign to make the case for adequate funding and to secure it. Unfortunately, that did not happen this year and it is setting back Sláintecare considerably.

Having said that, I welcome the important work that has been done on productivity. The recent assessment of additional funding and staff found there had not been a corresponding increase in productivity. There are some fundamental problems here, and some policies working against each other when it comes to improved productivity. I have to question some of those and I just cannot get to the bottom of them. In my view, however, the more money that is put into the NTPF, the more work that is taken away from the standard working week within our public hospitals. If a lot of work is being funded in private hospitals or public hospitals, then naturally the quantum of work done in public hospitals would seem to reduce. There are two things working against each other in that respect. I understand the reasons behind it, and it is welcome in itself, but the additional funding provided for community diagnostics is being paid to the private providers now springing up all over the place. That is work that should be core to public hospitals, and it is being done outside. Too often we see that the response to waiting lists is to outsource work. That is right across the health and social care system. We will end up in a situation where investment funds own the bulk of our heath service. That is not a place we want to be. It is like what is happening in housing.

Where is the digital health strategy? It was promised last September. It was then promised in March, and we are still waiting for it. While work is going on with aspects of that, there are a lot of people across the health service who are waiting for that strategy or framework to be published. Will the Minister please do it? I hope he is not waiting until closer to the elections. Why is it not being published? It is holding up valuable work that needs to be done.

I spoke to the Minister about public health nurses on the fringes of the INMO conference last week. Often there is not a full understanding of the critical role that public health nurses play. They are the first line of defence for newborns, children and older people, yet they seem to be the least valued within the health service. I tried to get to the bottom of this because one of the impacts is that in large swathes of the country newborns and young children are not being screened at the point they should be. Critical opportunities to pick up conditions that could be treated at an early stage are being missed. I went about trying to establish how many posts there are around the country because it is a postcode lottery. I asked how many posts there are and the vacancy rate. The reply I got from the HSE is that it does not keep records of vacancies. That is incredible. It is another example of how, if you do not measure you cannot manage these things. I have taken it up with the head of the HSE because it seems extraordinary that it cannot tell us how many public health nurse vacancies there are.

A key issue I am now coming across is that while there seems to be an adequate number of places and they are being offered, a considerable number of people are not taking them up because they discover the training allowance is lower than the allowance for other specialist nursing training courses. These are postgraduate courses. People may have family responsibilities, be paying a mortgage and so on and they cannot afford a drop in income. Will the Minister look at that? It is a key problem. This year there are even fewer training places than there were last year. Will the Minister take up that issue?

When will the Government introduce salaried GPs to address the dire shortage that is there? Many young GPs would willingly take on a well salaried post and would be happy to go into public service. They would also be happy to provide out-of-hours cover, which is so desperately needed. For a large part of the 24-hour cycle, people have no choice but to go to an emergency department because fully operational out-of-hours services are not available. There is no blame attached to the GPs who are working during the day, but there should be special separate coverage at night. I ask that salaried GPs be introduced. There would be huge uptake.

On the general issue of outsourcing, when there is a problem the Government goes to the private sector. That might lead to a short-term saving in respect of pension rights and so forth, but ultimately it is not-----

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