I wish to alert Senators, Deputies and councillors around the country that we have a significant problem with healthcare assistants. The reason for this problem is that we do not have enough of them and the reason we do not have enough of them is because they cannot come to this country under what we call critical skills, which involves eligibility to come and work here. There is a lack of suitable staff in our voluntary, private and public nursing homes. I do not know whether or not anybody has noticed but we have an ageing population. We are getting older and those who are becoming frail and feeble in their homes, communities or nursing homes need healthcare assistants. They need healthcare assistants to feed, wash, turn and dress them and to be their friends because they are there 24 hours a day. We cannot get candidates in Ireland for these positions and we are looking outside the EU. We are looking to the EU but it has its own problems.

I am calling on the House to think about this. I have written to all the Ministers about it and am trying to organise some way of changing eligibility. Did Senators know that a person can come here as a bone person within an agricultural setting or that a person working in a meat factory or a sheet metal worker is eligible, but a person is not eligible if he or she is going to deal with a human being for 24 hours every day of every week of every month of every year who happens to be in the home or community or trapped in their own homes? It is extremely important that we have a pilot scheme with India and Mauritius, particularly India. Our Taoiseach is from an Indian background. The greatest doctors and nursing and medical staff have come from India and perhaps it is time we set up a pilot programme to see how we can work this.

We should come together across all divides here to address this problem because most of the young people who come to help must either re-apply for visas and are ineligible because they do not come under what are called critical skills. It is very simple. We could expand the definition and organise our lives as we grow older. We need these people. When people talk to me about immigration, they do not know what they are talking about. We need people to come from other countries to help us stay alive on our own island as we get older and as our children grow up and get educated. What are we talking about? There are all the wrong inferences about immigration. I am sorry the Seanad is not fuller but will the Senators think about this because I will pursue it over the next two or three weeks?

I second Senator McDowell's amendment to the Order of Business. I think that thing is insane.

I wish to speak about general practice. As most Members know, I am a GP working at the coalface. I will explain some of the changes that were announced recently. Last Saturday, the Taoiseach and Minister for Health announced some preliminary agreements for changes to contracts for GPs. A full general medical services contract has been promised since April 2017 - two years ago. Assurances have been given that negotiations are slowly moving in the correct direction. The increased funding of €210 million over four years sounds impressive but it might be slightly misleading.

Given the pedestrian nature of the talks so far, any progress is welcome but I would like to explain in more detail how this money will be spent. I and many other GPs across the country have serious concerns about details of the agreement with the IMO. In 2014 alone, €219.8 million was cut from general practice to medical card patients. Capitation rates were, in effect, cut by 38% due to the expansion of entitlements to free GP visits. The Government appears to be trying to play the same trick by introducing free visits for six to 12 year olds while not actually funding the policy. We have a trolley crisis because GPs are overstretched. For every €1 spent on primary care, €5 is saved in the rest of the health sector. If a proper general medical services contract was negotiated with GPs, midwives and nurses, we would not be in a situation where patients have to wait hours on end in accident and emergency departments to be seen and are then left on a trolley waiting for a bed. Patients would be seen before their health deteriorated to the point where they needed hospitalisation and hospitals would not have to be used as the first point of care for patients who are unable to get appointments with GPs or a public health nurse.

When I left Wales a number of years ago, there was a four-week waiting list to see a GP while in Ireland it is looking now like one week. We used to have same-day access only a few years back. As of 1 March 2019, just over 2 million people, or 42.6%, of the population had access to free GP care. While this step forward towards universality is wonderful and I applaud it and while I support Sláintecare, time and again the Government has announced new healthcare policies without considering how to fund them. Hence, 80,000 people have waited 33 weeks for the results of smear tests. I have patients who had a smear taken in August 2018 and who have still not received a result. They come in and ask me where the results are and when they are going to get them and I say, "I don't know". We do not know because we have been kept in the dark, which is a problem.

Rural and deprived urban areas cannot recruit young GPs. That means this cohort of patients is being disenfranchised, yet the Department of Health can overspend its budget by €1.3 billion, which does not even take into account the national children's hospital overspend. If we are to be serious about providing adequate primary care services nationally, especially in rural locations, we have to look at putting a proper contract in place as soon as possible. The FEMPI cuts must be reversed. This is about providing care to the most vulnerable patients who, in this country, are patients with medical cards who live in urban deprived areas and rural areas which cannot attract a GP. It is unfair. Patients have to travel 30 km to 40 km to access GP services. I ask the Leader to consider having a debate on this matter, which is one of major importance. GPs are the front-line soldiers in the battle within the healthcare service. If we do not have an adequate primary care service, we do not have a health service at all.

I thank Senator Marie-Louise O'Donnell for raising a most important subject on which I agree 100%.

Hear, hear.

There is a lot of talk about immigration and keeping them out and whatever. We need these people. Of course they have critical skills. I back that 100%. I also second the proposal by Senator Norris to amend the Order of Business.