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

When I had the pleasure of visiting St. Luke's Hospital some time ago, I got first-hand experience of what is being achieved there as opposed to what is trying to be achieved. Many issues have been raised today and questions on them have been answered. Given that the model being developed and expanded by Dr. Fawsitt and Professor Courtney and their colleagues is successful - I refer to integrated systems, streaming of patients and patient flow, management in the communities and good links between GPs, hospitals and other allied health professionals - it is amazing that it has not caught on across the rest of the health service. I suppose we should try to see where this successful model can be used. Most people have referred to it in various committees over the years, before we ever decided to have a ten-year health strategy. It has been held up as a flagship, but flagships should be beacons and we should all be trying to get where we are.

What is the nature of the institutional resistance at management and professional levels? I assume there is resistance within the various clinical professions that are there. What walls were put in front of Dr. Fawsitt and Professor Courtney, or between them, at the embryonic stages of the development of this model? Are those walls still present in the broader health system? What can we do to ensure we try to break them down? Even though we aspire in our primary care strategy and our individual deliberations to everything Dr. Fawsitt and Professor Courtney have said here today, we continually seem to be shovelling money into acute hospital settings as part of a fire brigade-type effort, while at the same time squeezing the life out of primary care to make sure more people end up in the acute hospital setting. The eternal cycle goes on. I would like the witnesses to expand on the institutional issues.

The GP contract is coming up for negotiation. Reference has been made to chronic disease and illness. It has been suggested that diabetes should be managed in home care and in the community base. Similarly, chronic obstructive pulmonary disease and many other chronic diseases and illnesses could be managed in the community. I sometimes wonder whether we use our nurses and nurse specialists effectively across the health services. Do the witnesses think enough emphasis is placed on nurse-led programmes in the community under the guise of the GPs in that area?

We have raised the issue of diagnostics on numerous occasions. Every GP tells us that access to diagnostics is a problem. Dr. Fawsitt and Professor Courtney said in their submission that access to diagnostics should be independent of hospitals. If we did not organise the system in that way, the emergency departments of hospitals would be full of people who come through the front door. That setting always takes precedence in terms of capacity. What do the witnesses mean when they say that diagnostics should be independent of hospitals? Do they mean that they should be physically independent, or that they should be based in regional primary care or urgent care centres? What do they mean when they use the word "independent" in this context? Who would be managing them?