Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I welcome the delegates and thank them for attending. I had the pleasure of being welcomed by them in Carlow–Kilkenny a few months ago and was very impressed.

I wish to refer to a few issues, including the structure of the HSE, the regional health organisations and the separate social and mental health care services. In Carlow–Kilkenny has this issue been addressed in the model? Do the delegates have a mechanism by which those involved on the social care side, in psychiatry and mental health services feed into their system? Has their model addressed what I would regard as the lack of integration within the structural part of the HSE?

My next point follows on from the discussion with the previous delegation. In the experience of the delegates, do they compete with the acute services in the hospital in terms of access to diagnostics in Carlow–Kilkenny? Are they fighting for space and, if so, how does it work out for them? Have they suggestions as to how to improve the position in this regard?

In the previous session we spoke about the deprivation index. When the delegates are following the care pathway for a patient through this system, are there loss leaders, a term used in retail? Are there patients with very complex conditions who follow the same pathway as others but whose care is not being funded adequately? Is this at the expense of somebody else? How are the cases of patients who require particularly complex care managed? Does it work out in Carlow-Kilkenny?

On the social and mental health care aspect of the health service, do the delegates have very good relationships with public health nurses? Is there a maternity service in Carlow-Kilkenny?

I presume that is the case. How do maternity services work there when it comes to public health nurses dealing with a woman once she has had her child? Does it have a domino scheme similar to the one at Holles Street where maternity care is midwife-led?

Reference was made to GP-led primary care. Why would it only be GPs? Do the witnesses mean GPs being at the head of it and somewhere below that community pharmacists and others being involved? How do they envisage community pharmacists, public health nurses and people working in the community fitting into the structure? I know that the approach is completely fragmented and that a great deal of time is spent on the telephone to people. There is also the issue of the errors that can occur during a telephone call and the number of fax messages that are sent. People in other organisations do not use fax machines as much as doctors, pharmacists and agency personnel. They laugh when one mentions a fax. How do we get around the cultural issues that were referenced? How do we make everybody in the system feel important, loved and appreciated?