I propose to take Questions Nos. 625 and 626 together.
The health and social care needs of individuals/families/communities are met by Primary Care Teams, which include general practice (GP and Practice Nurses), physiotherapy, public health nursing, occupational therapy, etc. and through the broader range of Health and Social Care Network Services, e.g. psychology, dietetics, podiatry/chiropody, audiology, community ophthalmology, etc. who work with a number of Primary Care Teams. Public Health and Community Nurses are key members of Primary Care Teams.
Due to the challenging financial environment that has prevailed and continues to exist, the moratorium on recruitment and recent exit schemes, the provision of primary care team and network services, including public health/community nursing services, have been impacted on and severely challenged in many instances. Contingency planning is ongoing in this regard in order to ensure quality safe services can be delivered and these include : redeploy staff across HSE areas, where possible, in order to fulfil the HSE's statutory obligations; merge Nursing Management functions across Health Areas; consolidate nursing functions across Health Areas, such as, administration, Home Care Packages, etc.; examine existing service provision with respect to eligibility.
Planning for the delivery of health services is undertaken within the context of the annual National Service Planning process. This process ensures that all factors, including budgets and staffing levels and any other emerging issues, including the impact of the retirements under the ‘Grace Period', are factored into the plan for what services will be delivered within the coming year.
In line with the commitment in the Programme for Government to significantly strengthen primary care services, funding of €20 million has been provided for in the HSE's National Service Plan 2012 to fill as many vacancies as possible and to expand existing arrangements where sessional services are provided by allied health professionals. This will be increased to €25m if it can be established that there is scope for further savings of €5m in demand-led schemes. Proposals are underway for the filling of these posts, which will address priorities that have been identified by Health Managers. This process is being overseen by the Universal Primary Care Project Team established to oversee the future development of Primary Care Services.
It is recognised that under the former Health Board system, many practices evolved locally in response to local patient demand with the express purpose of providing responsive primary care services to patients in order to avoid further deterioration of their conditions and possible hospitalisation. This led to variations in practice which result in inconsistencies of approach and differing levels of service in certain areas of the country.
However, it is worth noting that under the Maternity and Infant Care Scheme services are provided universally to both medical card and non medical card holders. Similarly, Public Health Nursing (PHN) services associated with child health are provided on a universal basis and the dissemination of information and advice on health by PHNs are provided universally to all sectors of the population.