Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

Having made it this long, it would be a terrible sin to bite my tongue and disable myself before I start. I thank the Chairman. I congratulate the Minister and his officials for coming before the committee and engaging so openly and readily with it. This is a big challenge for the Minister and for his Department. The challenge in health has been there for at least 15 or 20 years. Targets have been set many times in the course of that period. However, they are moving targets. By the time one attempts to achieve the target, it has moved again. From what the Minister has told us, I would conclude that he is moving in the right direction. The Minister will know better himself whether he will be able to hit the targets in one fell swoop. That remains to be seen. However, it would be hugely beneficial to the morale of the health services, the morale of patients who are on waiting lists and the morale of the people generally in the country.

Health services affect every single household in the country. Various other services affect them for a period of their lifetime, but health services affect them for their entire lifespan. We are allegedly growing older, some of us more quickly than others. The point at this stage is that it is a better job to be able to take corrective measures halfway through a cycle rather than waiting until the end of the cycle when one realises that one's targets are not going to be met. I recognise the danger there is of becoming a hostage to fortune and allowing outside interests to dictate where one is going. The best of luck to the Minister with it.

Deputy O'Connell rightly made the point about legal issues. I mean no disrespect to my legal colleagues, of course. The fact of the matter is simply that patients in general, but more often than not women, find themselves in enough difficulty facing a traumatic situation without having all of the legal consequences trotted out before them and having to undergo all the probings that take place associated with that. Why is there not a system without prejudice that would initially examine a situation without making the Department liable for endless costs and whereby there would be some recognition of the trauma through which the patient has gone as a result of an accident or whatever the case? One does not have to concede. There are procedures for doing this. I do not know if such an approach has been found possible. I was involved over the years, as I am sure was everybody else here, with different patients who found themselves in that situation. It is deplorable. At the end of the day, when and if the case goes to court, having cost millions of euro in legal costs as well as everything else, the compensation has to take place. Why not look at it at the beginning, try to cut the ancillary costs and move towards that?

To what extent can one avail of the benefit of membership of the European Union in the control of drugs? It is a large market of 500 million people. When I was a member of a health board we had this argument. There is always a tendency for the drug manufacturing companies to exert power and influence to the detriment of smaller countries and allegedly smaller markets. We are not a smaller market. We are a very large market. We require and demand the best that is available through that.

The issue of waiting lists is something that has been going on for years. The Minister is moving in the right direction with his initiative. Hopefully, the combination of the primary care centres on the one hand, strengthened services through the GPs on the other hand and step-down beds will enable a more accelerated programme to develop. Over the years I have tabled a number of parliamentary questions on the effect of the primary care centres on the waiting lists in their adjacent hospitals. The answers I received were not convincing. I have visited some of the hospitals adjacent to primary care centres and have found that the patients in many cases are referred past the primary care centre and on to the general hospital. That should not be happening.

There is another issue that my colleagues have made reference to around attracting, educating and retaining medical staff of all levels in the country. That is a problem.

Unfortunately we are not likely to have the climate they enjoy in Australia. We will never have it. It will not happen that way. There has to be some other way we can encourage our qualified medical people to remain in this jurisdiction, at least for a while, to benefit the health services here and to benefit themselves.

To what extent does the Minister see the GP contracts featuring in this in the first instance? Does he see an opportunity there? We have had much criticism of the GP contract in recent years and dissatisfaction, particularly in rural areas but also in urban areas. To what degree does the Minister see the possibility of dealing with it? This is the first step. If this cannot be resolved at an early date, then the other down the line issues will accumulate and continue.

I am suspicious about the availability of drugs at a very high cost. They are under patent for a certain number of years but it worries me when I see the costs associated with them. Whatever moral pressure can be used, even if it involves using the resources of the European Union, it should be done.

I congratulate the Minister on the initiatives so far. He mentioned who has control over some aspects of policy in the HSE. The Minister has control and he needs to exert it. The delivery of the services is under the amorphous mass of the Minister, the Department of Health and the HSE. The HSE is the instrument which delivers at the coal face. There is a tendency from time to time for policy decisions to emerge as if they were by gradual growth and development over time. Not all of these decisions are soundly based and I am concerned about them. The important thing in all of this is that the decisions ultimately rest with the Minister. In the old days one tabled a question in the Dáil, which was answered by the Minister and one received the reply immediately. That was in the days of the health boards. We did not have to wait for anything. Then the HSE came on the scene and when that happened we received no answers at all in the House on issues relating to what the HSE was doing. That was appalling. Five years ago a change was made to the effect that we wait for 15 days and then get the answer. It is an improvement but more needs to be done.