Martin Daly challenges ministers on health digitalisation and retention

Thank you very much Minister and Ministers and Department Officials. I am going to try and do a question and answer because we might get more views from you on what is happening in the health service. I am delighted that the investment is increasing year on year, but I am struck by your own observation that we are not getting return for our investment. There are a number of issues that come to mind. One is the capacity issue. Are we growing our health service quickly enough for the growth in our population? Are we putting investment into parts of the system that cannot perform without other parts of the system being reformed? For example, you have the digitalisation of our health service. If you will forgive me, I am delighted your focus is on that, but being involved in the healthcare sector for many years I have heard this story repeatedly. I know that in the general practice setting 98% of all GPs are fully computerised and have to be for the chronic disease management programs. But in our hospital sector we still have a situation where if I do a referral in my surgery to a hospital sector, a digital referral, someone on the other end of it prints off a hard copy and walks around the hospital handing out that sheet. We have heard about this for many years. This country is one of the biggest centres of the digital economy in the world and yet we do not seem to have extrapolated that into our health service. That is just one. The second thing is we have taken on more and more staff. There are two issues that are arising. One is retention of Irish graduates here in our system. Many stories coming back about the culture. It is not simply about money, but it is about culture. Are we treating not just our medical graduates, but our allied health professionals and nursing professionals properly properly when they come into our system? Are they welcomed into our system? Are they facilitated in our system? The narrative coming back is they go because they are treated better in other jurisdictions when they leave here. That is a culture issue and not a money issue. I am glad you referred to the NTPF. I would hope that there would be some reform around the NTPF, given some of the issues that have arisen recently. Around primary care centres, we are very reliant on the private-public partnership. In a number of areas of the country, in Ballahadrine and County Roscommon, Edgerordstown and County Westmead, we have situations where small developers have gone out of business or have not satisfied the financial requirements after years of planning and the primary care centres have fallen through. Are we over-reliant on small developers producing these primary care centres? Should we just be having the HSE direct build these centres? I will leave it at that for the moment. Thank you. A couple of different things there. On the digitisation, yes, I appreciate you have heard about it before. To be fair, we would not have been able to download the HSE Health app unless a substantial body of work had gone into that. We have about 75,000 people who have downloaded it now and it is the first step in relation to this. This comes down to the investment decisions in the NDP about being able to take this forward. I do not have the health budget at the moment to do that, excuse me, but you can clearly see that the priority in the programme for Government is around health digitalisation. I suppose my own view is that it should be digitalisation and other infrastructure, but we will have that argument a different day. But I do see a clear pathway to funding a different digital system. Derek Tierney here is with me who is doing the work on driving that. There is a very clear plan, a very clear plan for the spend and I can see a clear pathway over a number of years about the different stages of that and the delivery of that. It is absolutely essential for what we are doing and the inefficiencies that you highlight are particularly frustrating and they must be very frustrating for people working in the system. We have quite a body of work in relation to do that. Secondly, you asked me about the, sorry, just so that you know, in relation to just as an update on the progress for the national electronic health record, the business case is being developed and it is currently subject to the external assurance process before it goes to Government. A prior information notice, which is a key part of the procurement process, was published in June 2025 and that informed different EHR suppliers about the health services interests in a national enterprise level EHR system and a national electronic prescribing service tender was published in June 2025 as well to develop secure and efficient transmission and storage for electronic prescriptions and dispensations for patients. So those are just crucial updates in relation to it. But I would also then bring in in relation to electronic health the virtual wards in Vincent's and Limerick. I would like to see more rolled out. It's very effective. You can have two nursing staff working overnight for 30 patients, which you really wouldn't be able to replicate in a hospital setting. And the outcomes are very good. And I'd invite you to come to Vincent's or to Limerick to see it in operation. Though if we give funding for the capacity to have 25 or 30 patients, I do expect the hospital to bend over backwards to find those patients out of 550 beds to make sure that it's being utilised properly. And I was, for example, very disappointed to see what I regarded as the underutilisation of a virtual ward over a bank holiday weekend, you know, impacting beds. So on the staff retention, I think one of the most important pieces there is how we treat our workforce and how we enable our workforce. One of the key things that I hear repeatedly and which Rachel Kennehear, who is in charge of workforce planning across the board, is we are trying to give everybody the opportunity to work at the top of their licence. In particular, I think it's fair to say we see the best outcomes with advanced practitioners, whether it's in nursing, whether it's in social care, and what we can do further to empower them more in leading diagnostic and triaging in different clinical settings. Is there anything you'd like to add to that, Rachel? Is that okay? Yeah, retention is a big feature of our overall workforce planning. And just to summarise, I'll be happy to provide a more detailed note on this. But for NCHDs, the task force concluded last year, made a significant number of recommendations and we've already seen improvements in induction programmes and facilities within all of the hospitals for on call for training and development space for NCHDs and doing longer hours. There is a commitment to the reduction of European working time directive, which has always been kind of feedback from doctors themselves. There are significant recommendations around training and education and improvements in simulation for doctors that are being progressed. As I said, we can provide a detailed note on that. From a nursing perspective, we have the safe staffing framework, which has had significant benefits and has shown through evidence of better retention for areas that have fully implemented the safe staffing framework. In addition to that, we are part of the European nursing action, which has a strong focus on retention of nurses right across the European region. Migration is a feature of our workforce in Ireland and will remain so given our dependence on international trained workforce. However, we are beginning to look at circular migration. What we are seeing is that while our new interns from a medical perspective and nursing graduates are migrating to countries like Australia, we are seeing them coming back into the workforce between three and five years' time, which is significant for us. Once we get better data on that, I think we will see improvements. I think it is also important to take a global perspective as well and recognise that there are many, many nurses coming to Ireland at the expense of their home countries. I think of the Philippines in particular, who produce 13,000, trained 13,000 nurses a year, 10,000 of whom leave to go to different parts of the world. At the World Health Assembly, I sat with the Filipino Minister to recognise we are doing a lot of work to try to support those nurses and their families and to have that circular training. It is not just about us taking from other countries. We have an obligation to make sure that we are not doing that at the expense of other populations around the world. We are quite conscious of that as well. In relation to NTPF and insourcing, this is one of the most important pieces of work, a because of the proper processes involved in it, b to ensure there is no corruption of those processes, and c to ensure that it is not operating as a barrier to us getting to a universal public system. I became aware and concerned about this at an early, early stage, six or eight weeks into being Minister. And it arose from constantly asking about the use of the CT machine and the diagnostics. What time does your CT machine run to? What time does your CT machine run to? Is that for emergency or is that for elective? And what happens on Saturday? Or you would hear in a hospital, you would hear, oh, but the MRI machine, it doesn't work on Saturdays. How does it not work on Saturdays? Does it need a rest? Or what is it? But it turns out in some of the hospitals, it is working. It is just not necessarily working in the public system. So what are the constructs behind that? And it is not to say that they are not legitimate and that they have not been developed with knowledge and purpose, because they have. They have been developed for the purposes of trying to meet patient need and reduce waiting times for people who need surgeries and who need diagnostics in painful conditions. Our difficulty is, I think, and we will see with the insourcing review, we don't have, until this insourcing review that Burnett has completed, a real understanding of what is happening on a site-by-site basis, what the national implications for that are, how that is being used in different ways, how that has the capacity to be used wrongly, in my view, even if legitimately, but wrongly in delivering the overall public good of a public system working at maximum productivity. Thank you. I will come back on the private care centres, so I will ask Derek to you specifically.