Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Deputy Durkan and I assure him I am very clear on how policy is made in health, and in every other area. Health policy is made by me, in consultation and with the agreement of the Oireachtas, advised by the Department. The job of the HSE is to get on with implementing and delivering it and dealing with operational matters. It has a lot to keep it going on this front in a very busy health service. We work very well with it in this regard.

I thank Deputy Durkan for his kind words. I agree with him that the health service faces a huge challenge. This is the case not only in Ireland but throughout the world. We see the impact of health debates in many other countries. There is a tendency to always believe faraway hills are greener. People speak to me about the NHS as though it were a magical wand solution and if we just lifted it and put it in Ireland everything would be wonderful. However, if access information on the NHS, for example through Google, we will see references to doctor strikes, financial sustainability and bed capacity issues. These are many of the issues we are debating at this meeting today. There are challenges in every system and there is no such thing as a perfect system.

I am genuinely positive about this, and while I was getting all of the messages of sympathy wishing me well in Angola, as it were, and telling me to be careful of the poisoned chalice, I do not buy that. Many positive things happen in our health system and I am more convinced of this than ever. This is not to in any way belittle or dismiss the huge challenges that exist for patients and staff in areas of health service. If we look at the five-part series on RTE, "Keeping Ireland Alive", which showed the many excellent practices going on in the health service, and matters such as life expectancy and how we deal with things such as cancer, cardiac care and stroke and the progress being made in Ireland - this is not a political point as it has been made over successive years by health care professionals - we have a lot going right.

The key issue is whether we can do what we have never done before, which is stop playing politics with the health service. This does not mean stopping holding me to account for the day-to-day running. I get this, and there is plenty for which to hold me to account on a day-to-day basis. That is fine and that is politics, but can we do something we have never done before, which is agree, no matter who wins the next election, the one after that or the one after that, on a direction of travel for the health service? If we can do this we can break the cycle.

What is happening at present is very straightforward. Ministers turn up in Hawkins House, spend a period of time there and have a few ideas but because they may following a Minister of the same party or a different party, everyone has a different emphasis. People make changes and begin a process. Then the Minister moves on, a new Minister comes in and the whole thing starts again. When I speak to health care professionals, managers and patients' groups, it is not fair to say people are fed up of reform in the health service, but they are fed up with little bits of reform and never getting to complete the journey. In this respect the work done by Deputies O'Connell, O'Reilly and others on the Committee on the Future of Healthcare cannot be underestimated. If we can get this piece right we can set the health service on a path of which we will all be very proud. The country has done it before. It has done it on the economy and on Northern Ireland and the peace process. We need to stop accepting the premise, as Deputy Durkan certainly does not, that the issues in the health service cannot be addressed, albeit they are serious challenges.

The Deputy is right about the morale of staff in the health service and of patients. We have a duty to provide them with a sense of a forward looking direction of travel. This is not me sitting here suggesting we can rectify every issue today or tomorrow, because we certainly can not, but we can make inroads into all of the challenges we face in an incremental way. I have a duty of care to staff and patients to outline to the Oireachtas in the coming weeks how I intend to do this.

I agree with Deputy Durkan on providing opportunity and space in the health service to provide information to patients who have had a bad, negative or tragic experience. The Deputy is right that sometimes, very sadly, things just do go wrong and there can be a genuine tragedy. In such a case the patient and staff need information. I believe open disclosure, the policy we have in place but underpinned in legislation, will address this.

I agree with the Deputy on drugs. We cannot allow countries to be picked off by one another. We are in a common market. It is more complex than I presented it, but we need to examine how we can work at European level. I have begun these discussions informally with colleagues and I hope to continue them at an EU Health Ministers meeting next week on an informal basis. Some countries have already grouped together informally and they are beginning to see the benefits.

I am glad the Deputy raised the issue of primary care centres. They have a huge role to play but not if we view them as only bricks and mortar. I was in Senator Colm Burke's area recently, where he was a councillor for many years, for the commencement of works on what will be the largest primary care centre in the country. It is fair to say there was palpable enthusiasm and excitement from the residents. It is the largest public investment project on the north side of Cork in 30 years. It is a huge project and will provide a central focus as the place for people to access primary care. This is important.

Infrastructure is clearly important, and we must provide the bricks, mortar and facilities, but what is more important is what happens in the primary care centre. The parliamentary question asked by the Deputy, which was legitimate as the Deputy's questions always are, is very difficult to answer because if the primary care centre is only largely providing current GP services and a few other important services, but not anything above and beyond what is been done at present, people will end up in emergency departments. We need to look at what is being done in acute hospitals which does not need to be done there which we could provide in primary care.

This brings me to the next point the Deputy asked about, which is the issue of the new GP contract. I know the Chairman has an interest in this and has raised the issue with me To have a new contract we need two sides which both need something and I believe we have this. I hear very clearly from GPs that the current contract does not work for them. It does not enable or empower them to do what they believe they can and should be doing, which is what I also believe. It also does not work for the State because it does not enable our GPs, who are our primary care providers, to do all they can. Therefore, the mythical Mrs. Murphy finds herself in hospital because she cannot access services at primary care level, which our GPs are qualified and trained to deliver. A big example of this is chronic disease management.

The data on chronic disease management indicates that the number of people developing chronic disease is increasing, with people above the age of 50 years often suffering from two or more chronic diseases and people developing chronic disease at a younger age.

If we cannot manage chronic disease in the primary care setting then no matter what we do in the acute hospital setting we will not address the challenges and, in fact, they will grow. We intend to commence a contract negotiation process by the end of this year. Along with my officials and the Health Service Executive I am looking at a number of options in this regard, including the most appropriate arrangements to engage with GPs and other primary care stakeholders. I am eager not to go down a silo route in terms of having a conversation with only one group of health care professionals in primary care only to find out at a later stage that another group is doing work in this area, such that we end up duplicating work. There is a piece of work that needs to be done in regard to engagement with all primary care stakeholders on issues such as what the future of primary care will look like. This process need not go on for a long time. We need to advance that process and to then commence the contract negotiations and put in place that structure by the end of the year. Work in that regard is ongoing. That could play a major role.

There are things that we are doing today in terms of helping keep people in their communities. For example, the purpose of a community intervention team is to ensure that an older person is kept rehydrated within his or her home such that he or she does not end up in the emergency department. Deputy Durkan will be aware that under the service plan for this year, an additional 1,030 patients will benefit from community intervention teams and another 6,643 will benefit under the winter initiative. We are particularly and unapologetically targeting frail elderly patients so as to avoid their having to be admitted to hospital in the first instance. All of the data indicates that when an old, frail person goes into hospital this can have a detrimental impact on his or her health. If we can keep elderly patients in their home, and well in their homes, they can live longer and more fulfilling lives.