I thank the Minister of State for coming in here today.

Physician associates in Ireland are healthcare professionals who work under consultant or GP supervision. It was lovely for me to learn about this role because I did not fully understand it until somebody approached me about this. Physician associates support medical teams providing continuity of care by taking patient histories, conducting exams, formulating diagnoses and managing care. They work mainly in hospitals across surgical and medical subspecialities offering a stable presence compared with rotating junior doctors. I did not really understand this role until a lady called Emma came into my office looking for help. I also did not know that our own very valuable hospital in Navan has added physician associate roles as valuable members of its medical team.

I will start with Emma's story. She said:

Linda, I'm looking for your help as a government representative. I am currently undergoing a 2-year masters in the Royal College of Surgeons Ireland in a new healthcare profession. The profession is called Physician Associate. The role which began in 2016 involves working within the medical team under the supervision of a consultant or GP to diagnose patients, order tests, perform procedures, assist in surgery, and provide continuity of care among many other responsibilities. The role originated in the US and is very well established there now with Physician Associates providing care across all medical specialities. RCSI Physician Associates train to work in the Irish Healthcare System, a system which is falling apart at its seams with overcrowding, unprecedented waiting lists and ill resources. The problem currently affecting our profession is a pause in recruitment by the HSE while they undertake a review into the profession. The HSE has funded this master’s course for all 26 of its current second year students with an undertaking for us to be employed by the HSE for 3 years after we graduate. The course fees are approx. €24,000 which works out at approx. €600,000 which has been financed by the HSE. There are currently four Physician Associates working within Our Lady's Hospital Navan and I have seen first hand the impact they are having on our local hospital. They facilitate extra clinics; they have added extra surgical lists, and they are a constant member of the team for patients to see every time they revisit the hospital.

Emma goes on to explain that it is a worrisome time and that she and others do not know what is happening. The pause in recruitment means a pause in their lives with some graduate students currently on jobseeker's benefit and others working in retail. They are a trained Irish workforce that is motivated to work and is looking for help to get that going forward. I put in a representation to the Minister for Health and received an answer from the workforce reform policy unit at Department of Health that read:

The HSE committed in the 2025 National Service Plan to undertake an independent assessment of the Physician Assistant role. The HSE commissioned a review of the Physician Assistant role with the aim of making recommendations regarding the governance of the role, scope of practice, and appropriate and safe deployment in Ireland. The review has been completed and has now been submitted to the Minister for Health. The review makes recommendations with respect to governance and scope of practice. The Minister for Health has requested the HSE to submit an implementation plan by the end of February 2026. Given the commitment to carry out an independent review, the HSE decided to pause the recruitment of Physician Assistants. Following publication of the report, the HSE will work towards the implementation of the recommendations and the establishment of an appropriate HSE grade code for the role.

We are at a standstill. We have been putting this in since the beginning of the year. We were told that we would see the implementation plan by the end of February and I hope the Minister of State has an answer for me and can tell Emma and other people who are studying for this role that they will see light at the end of the tunnel.

I am very grateful to Senator Nelson Murray for raising this vitally important issue and its impact on health services across our country. I know only too well, particularly in Navan hospital, how important these roles are. The Minister for Health has asked me to convey that to her because it is recognised that future health services require new approaches. It is essential that patient safety is prioritised in the implementation of any healthcare role.

Due to a lack of clarity as to the scope of practice and governance arrangements for the physician assistant role, the HSE paused recruitment and commissioned an independent review of the role. As the Senator has outlined, the purpose of the physician assistant role is primarily to assist the medical team in its provision of care to patients. As permanent members of staff, they can play an important role in the organisation and co-ordination of care across the medical team and with other teams involved in the provision of care to patients and in enabling continuity of care for patients, particularly at changeover times.

The primary purpose of pausing HSE recruitment of physician assistants, commissioning an independent review and developing a HSE implementation plan is to support the safe and consistent deployment of the role across the Irish public health system. As committed in the 2025 national service plan, the HSE commissioned an independent review of the physician assistant role.

The review is led by Mr. Leo Kearns who is the CEO of the Royal College of Physicians of Ireland and the Irish Medical Council. He was also the national lead for transformation and change for the HSE.

An extensive consultation process formed part of the review, including surveys, focus groups, written submissions, verbal input and face-to-face meetings. Stakeholders consulted as part of the review included patient and service user representatives, the Department of Health, the HSE national functions and health regions leadership, clinical leaders, professional system regulatory bodies, educational and professional institutions, hospital and service management and trade unions and representative bodies. The consultation process also involves engagement with practising physician assistants.

As the Senator laid out, the review is now complete. The report made recommendations regarding scope of practice, clinical governance, supervision and employment. I am pleased to confirm to the Senator that the HSE will publish the report on Friday, 1 May 2026. The Minister for Health has received a report on the HSE’s implementation plan. The HSE is now moving to an implementation phase, focused on strengthening governance, role clarity and national consistency. During this implementation plan, it is expected that the HSE will communicate with stakeholders, including those working in and managing health services, educators and professional bodies. As the implementation progresses, officials in the Department of Health will continue to engage with the HSE and, crucially, physician assistants themselves.

I did not know that. It is great to get new information in a Commencement matter reply. It is great that the report will be published on 1 May. I urge the Minister of State to go back to the Minister for Health and let her know that I hope this results in ending the pause on recruitment so that we can keep that worry away from these students.

I will finish off by talking about the experience I read of another lady being a medical physician associate in Our Lady’s Hospital, Navan. She started on 23 March 2020, a time we all remember. She said:

I had completed my Emergency Medicine rotation and then elective placement ... I loved the team and was thrilled to be asked to stay. The hospital even hired 2 others in my class to be Surgical Physician Associates too! I was proud that the staff and hospital’s first experience of a student Physician Associate was a positive one. That in my time spent there I could prove our potential and that they were interested in pioneering this role in their hospital model.

She continued to document her time during Covid and said:

I am extremely proud though that I have been present as a Physician Associate on the frontline. That we have been given the opportunity to pioneer our profession and truly represent our practice as competent generalists throughout this crisis. So far our feedback has been really encouraging and we have all been accepted with open arms as valuable members to the team.

That is from a physician associate in Navan hospital. It can be seen how critical it is that we have these roles to help our healthcare system across all our hospitals. I thank the Minister of State for coming to the Chamber today. I urge the Minister and the HSE to move from the report and unpause these roles.

These reforms are to ensure that our health workforce keeps pace with future population and demographic changes. The reforms are necessary to build future workforce capacity. As of mid-2025, 38 physician assistants were employed in HSE-funded services in Ireland. The role did not have standardised roles and responsibilities, however.

With regard to training, the Royal College of Surgeons in Ireland, as the Senator outlined, offers a two-year physician associate master’s qualification. Graduates spend two years studying in good faith that there will be employment opportunities in the HSE at the end of their studies. The Minister for Health has requested that the HSE communicates directly with these students and graduates. Now that the report will be shortly published, students and graduates will have greater clarity on the role of the physician assistant.

I will bring everything the Senator outlined to the desk of the Minister, Deputy Carroll MacNeill. I sincerely thank the Senator for ensuring that this has been to the fore of the debate. I have no doubt the report and its recommendations, and implementation of same, will be something that will work better not just for our health service but, crucially, for physician assistants. The Senator has played a major part in securing that. I thank her for that.