Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I thank the witnesses for their presentations. We often discuss community care and primary care.

They seem to be the buzzwords in the provision of medicine and medical care in general. However, it needs resourcing. There is no point in us saying we can roll out these programmes of support for GPs in primary and community care unless we resource it and train professionals in the competencies required to deliver that care in the community setting.

GPs are obviously central to the provision of primary care in the community. Ms Burke spoke about out-of-hours GP services. We all know that GP services are under pressure because of financial constraints, the Financial Emergency Measures in the Public Interest Act, etc. Is she experiencing more difficulties in terms of provision of out-of-hours GP services? That is a fundamental issue for the provision of care either in the home, or in nursing homes or long-term care facilities.

We all recognise the central role of the public health nurse in deciding what care is allocated to people. It is very unfair to ask professionals, whose role is to care for and nurse people, to make administrative decisions over who gets care and who does not. It is very unfair that public health nurses, who are visiting patients in the home setting, very often need to decide on the number of hours of home help, etc. It is very difficult for those people whose primary focus is on the provision of health care to make administrative decisions on patients for whom they are caring. They should be resourced to extend that whole issue.

Professor Walsh spoke about the acute hospital setting and then post-acute. While he did not mention it, there is a pre-acute hospital setting. We need to bolster what is available in the community setting so that when patients are diagnosed every effort is made to support them even in the early stages of malignant illnesses or dementia before they actually slip into the acute hospital setting. Very often the resources are put in to get them out of the acute hospital setting in a hurry to free up a bed. There seems to be no planning from diagnosis to entry to the acute hospital setting and then leaving the acute hospital to go back into the community or long-term care. Is that something we need to consider? Do we need a planned approach when a person is diagnosed with a terminal illness? While it may be some time away does a patient plan need to be put in place? Every effort should be made to prevent them going into the hospital as opposed to getting them out of the hospital when they are in the hospital.

Among medical professionals is there resistance to registered nurse prescribers or do we just not have enough nurse prescribers? What is the difficulty in providing nurse prescribers with prescription pads if they are registered to prescribe?

On the consultant-led geriatric clinical teams, we have a scarcity of consultant geriatricians and in other specialties. Do they ever visit nursing homes? Is it possible to get in a consultant-led geriatrician team to carry out an assessment of patient profile and assistance in nursing homes or are they always referred back to the acute hospitals for assessment?