Michael Harty (Clare, Independent) | Oireachtas source

I, too, would like to raise some issues with the Minister. The Minister referred to activity based funding in his opening statement. I would like to explore the issue of moving from activity based funding to outcome based funding. In a situation where one doctor sees 50 or 70 patients and another doctor sees 30 patients, the doctor who sees 70 patients will have doubled his or her activity but he or she might not have doubled the outcome. The same applies in regard to hospital doctors who see an excessive number of patients in that their activity will be greater but the quality of care may be diminished by the fact that they are overwhelmed with work. Perhaps the Minister would consider moving from an activity based funding model to an outcome based funding model in regard to patients, procedures and quality of service.

There is huge benefit to be derived from the integration of services. In terms of IT, communication and medical records there is a huge amount of efficiency to be generated by having in place greater communications. We need to move to health records storage and access via cloud such that when a GP sees a patient he or she can access records to find out what treatment was provided by the hospital and so on. This improves communication and the quality of care to a huge extent. Perhaps the Minister would comment on that point.

The community health organisations are currently being developed and will be rolled out in the couple of months.

The community health organisations are being developed and will be introduced in the coming months. They are coming from the top down rather than from the bottom up and are viewed with some suspicion, notably by general practitioners. GPs would like local integrated care committees, LICCs, such as those in place in County Kilkenny to be examined. Under this model, all the components in the care process - general practitioners, consultants, nurses, HSE management, therapists and so forth - come together, treat each other as equals and reach an agreement on the best way to stream people in hospital. If we can stream people into hospital efficiently, we can avoid them ending up in casualty departments unnecessarily. They can be streamed directly into a bed or through a medical assessment unit, which avoids circumstances in which everybody ends up in the casualty department. The problem with casualty departments is that they have a catch-all function. Local integrated care committees are a more practical solution than community health organisations.

On recruitment and retention, if we can develop what I will describe as magnet hospitals that provide high quality care, these hospitals will attract high quality graduates. This has been achieved in Kilkenny. People want to come to work in the local hospital because its services are so well integrated. The hospital deals with complex cases and more ordinary cases are looked after in the community. This is the model the Minister wants.

Open disclosure is extremely important. As practitioners, we intuitively want to make open disclosure, which is the modern way of dealing with problems. It is not necessarily the case that a practitioner making an open disclosure is admitting that he or she was negligent or did something wrong. The option he or she or took may not have been the correct one or may not have had the best outcome. I ask the Minister to comment on the points I have made.