Professor Garry Courtney:

That is true. The acute hospital system is completely outdated. It was designed perfectly for a very small number of hospital consultants. When I went to Kilkenny Hospital, there were two physicians, no paediatricians and one radiologist. These are ridiculously low numbers and a system had to be built around the consultants because there were so few of them. The hospital now has 11 physicians, four radiologists and six paediatricians. There has been a major investment in the hospital system and taxpayers have stumped up for many improvements. Once a patient is inside the front door and before he or she reaches discharge, the Irish hospital system is extremely good. It does some things terribly badly, however, for example, management of chronic diseases, which should be dealt with by general practitioners in the community. People with chronic diseases should not even get into hospital and instead should be dealt with and paid for by GPs.

We were asked a specific question. The Health Service Executive has funded diabetes nurse specialists who work between the hospital and community. It also funded chronic obstructive pulmonary disease, COPD, nurse specialists, heart failure nurse specialists and physiotherapists to run pulmonary rehabilitation clinics. General practitioners have access to this service and we have opened the hospital to GP referral for echocardiography, certain extensive tests known as BNPs or B natriuretic peptide tests and all of them have full access to ultrasound.

Cultural change is needed and it must involve transferring a substantial amount of work to general practice. This must also be paid for. What hospitals should do in future is the high-tech work such as kidney transplants, an area in which this country is world-beating, technological medicine and the 5% of chronic disease that general practitioners cannot manage on their own. I would love to get to that position in two years. In that respect, God bless the Deputy's optimism but it took us a long time.