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

If I may, I wish to come back to the whole issue of outcomes for patients. We have pretty good measurements for outcomes in hospitals, which include average length of stay, waiting times, how many people are treated, how many are readmitted within 30 days and so on. However, we have very little by way of measurement of outcomes in primary care. As a general practitioner, I believe it must improve one's outcome to be able to see one's GP within 24 hours but I cannot prove it. If I could prove it, I would then know what activities GPs undertake that improve outcomes and those which are more questionable, which would let one focus on the areas in which one gets the outcomes one desires for the people.

There was a comment made that managers could have found more savings, had they more time. This happens continually and to cite Tony O'Brien from our tour of the hospitals in the system, yes, because of the way in which we have done budgeting the past, we end up making hard, snap decisions late in the year that are tantamount to vandalising the system. No one wants to be cutting home helps and home care, as that is the last place one would wish to be making cuts.

However, if a gun is put to one's head and one has to get cash, this is one of the few places to do so.

Next year that is not going to happen. We have put in place six financial people at senior level, one in each of the regions, one in the Department and one in the payments board. We are going to address this problem in a far more open way where people will have transparency around their budgets. That is the whole point behind the directorates. It is astonishing that we see 3,500 people in our emergency departments every day but we see 120,000 people in general practice every day. God knows how many people see the public health nurse and others in primary care, yet we have had no director of primary care. We will now have a directorate of primary care and there will be a clear line of budget, with the same for mental health, social care and hospitals.

We have to be assured that money voted by the Oireachtas for a particular purpose is used for that purpose. We saw a few years ago that €6 million voted for palliative care was not used for that purpose. In addition, money voted for mental health was used elsewhere. That is not acceptable and it undermines democracy.

Deputy Peter Fitzpatrick spoke about more investment in nursing homes to bring them up to the HIQA standard. There is a fund available for that in the capital plan. It is not a huge amount of money but it is there.

Deputy Mary Mitchell O'Connor's comments are apt. I have dealt with the cynical snap decision but we all tend to think of the worst case scenarios and hard cases, while forgetting about the rest. From my personal experience as a GP, one could see a couple of hundred patients per week. The person who was not happy is the one on a doctor's mind. One would forget about the other 199 who went away reasonably happy or pleased. I would not like to overstate the case in case ten of them come out of the woodwork but, on a serious note, we tend to look at the hard cases.

We have a very good health system, with excellent men and women working in it. We have some of the best doctors, nurses and allied care professionals in the world in this country. Some of the best managers in the world are Irish men and women, so why do we not have the best health service? That is the question. The answer is that over the years, government after government has allowed it to develop chaotically. I am not allotting political blame here because several parties have been in government in that period. We are now setting out to address this. We want to create a system, with the advice of those who work in it, that will allow them to deliver the excellence they have been trained to deliver. They are capable of delivering it and want to do so.