James Reilly (Dublin North, Fine Gael) | Oireachtas source

In response to Deputy Ó Caoláin’s questions about the west and north west group, the CEO’s actions and the appointment of the chairman, as is well known the chairman has stood down. He did not want any damage to his reputation or that of the hospital group. I share that concern. It is already on the record that the CEO has been admonished for failing to follow normal procurement rules. I refer the deeper questions to Ms McGuinness as the acting CEO.
Mr. Hennessy, who is the director of primary care, can answer the questions about primary care and medical cards. The Minister of State, Deputy White, will want to address some of those issues and I will defer to him on those.
I support the committee’s anxiety to see the Children's Health (Tobacco Smoke in Mechanically Propelled Vehicles) Bill introduced. There is a lot of legislation concerning tobacco and we are having trouble getting it introduced because of the pressure relating to legislative requirements. I am absolutely committed to both those Bills. I have given that undertaking.
I will let the Minister of State deal with the question about the GP care for children under the age of six. It was never going to be the case that any clause in the GP contract would prevent doctors speaking out if they saw inadequacies or wrongdoing or any other dangers for patients. That could never be the case. As a doctor and a Minister I would not stand over that, not in a democracy. It is not unusual for people to be asked not to bring their organisation into disrepute. One does not bring it into disrepute by pointing out its deficiencies and getting them addressed. The Minister of State can deal with that more comprehensively. I will ask Ms McGuinness to answer the question about palliative care on a county basis and the funding arrangements, and the figures for speech and language therapy for children.
The Minister of State with responsibility for care of older people, Deputy Kathleen Lynch, cannot be here today so I will comment on continuous care and the increasing number of people over the age of 85. People are living longer and they are healthier. That is the goal of Healthy Ireland – A Framework for Improved Health and Wellbeing, not just to increase the number of years one has on this earth but to ensure that one actually enjoys them and that we do not, as one colleague put it to me, die old, cold and incontinent. It does not have to be that way. The department of health economics in Trinity has shown that the last ten days of one’s life are the most expensive for the State and to die in one’s 70s, 80s or 90s costs one third what it costs to die in one’s 40s or 50s, so everybody can win. Long-term care in a nursing home is not the only solution. We are examining a range of alternatives with more home care packages, more home help, other sorts of tiered support within the community. I have visited some places where people stay. They are quite well, they get three meals a day and have a bed at night. Some stay there all the time and go out to do their shopping in their community but this becomes their new home, others stay during the day for company and go home at night, others sleep there because they do not like to stay at home alone at night. We have to address these different models that help people retain their independence for as long as is humanly possible.
I have addressed the gagging issue raised by Senator Crown. There is great validity in what he says about the trauma care centre. I was in Manchester last summer, where there are 4 million people and three trauma centres. They say that is ridiculous and they should have only one. We need to examine what our excellent hospitals do and realign the services in a way that gives the best outcomes for patients but also secures the future of the hospitals. For instance, does it make sense having two or three hospitals doing transplants when we should have one national transplant unit? Does it make sense, as Senator Crown says, to have between four and six emergency departments open in Dublin none of which is truly a trauma centre when one would probably serve the city or two certainly would? When I hear what is said in Manchester I believe one would do. There needs to be reorganisation but as Senator Crown points out, inter-hospital politics would be very problematic, because of the attitude of "what will we get if we give that up?" I believe a solution can be brokered if people step up to the line and stop thinking about their service per seand think about best outcomes for the patient, which we are supposed to be here to achieve.
I would be well-disposed to the weighting for non-smokers but we would have to consider it very carefully for unforeseen consequences. As a GP of over 30 years’ experience, I know that patients might be inclined to be economical with the truth in filling out life insurance forms if there was loading for being a smoker. If down the line one can prove that person was a smoker the whole policy is null and void. That sort of initiative can make such issues messy. It would need to be examined very carefully. I have no problem with the principle as a way to promote a healthy lifestyle.