Oireachtas Joint and Select Committees

Wednesday, 12 October 2016

Select Committee on the Future of Healthcare

International Health Care Systems: Dr. Josep Figueras

9:00 am

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

I thank Dr. Figueras for a very interesting presentation. I understand there is a view that our doctors are among the highest paid. As our Government keeps getting fined by the European Union for breaches of the European Time Working Directive, I am sure we can all agree that they are among the hardest working. I am not sure I would agree that they are among the highest paid but that is neither here nor there.

With the system of integrated waiting lists, we have a difficulty in particular in this country as we do not have a unique patient identifier. There are many people waiting for health services on multiple waiting lists. They may be on a waiting list for area A when the procedure could be performed more quickly in area B. We do not have a linked system and I am interested to hear Dr. Figueras's views on the extent to which the integrated waiting list system has worked in Portugal. I believe it has one of the best examples. There is also the necessity to invest in information and communications technology to support that system.

We keep coming back to primary care teams and I hope we are shifting, albeit very painfully and slowly, into a model that is more focused on primary care. The witness touched on the need for fully resourced teams and perhaps there should be a system taking in physiotherapists, for example. Is there is a gold standard or model we should aspire to in terms of staffing and skill mix for a functioning primary care team? Is there any data on the best ratio of patients to members of staff on a primary care team? Is there a case for deprivation weighting, meaning there would be more staff and resources, depending on the socio-economic make-up of the community that is being served.

I am not a nurse but I spent many years representing nurses. We have a serious issue with the skills that our nurses have, as they are very often wasted. We have health care assistants trained to qualification level five who could take on the work. It is a little bit like changing from driving on the left to driving on the right. One cannot do it incrementally and one must go for a big bang on it. I am just wondering if we could look at a model in this regard. I appreciate that nowhere gets the skill mix right. Is there somewhere that does it better than here? Currently, I know we have skilled nurses who are not using their skills to the best of their potential and doctors not doing the work they could and should be doing. Health care assistants are willing to take on some of the duties of nurses. It is a question of how we can shift that up. Is there a model we can look at? I appreciate that nowhere gets it 100% right but perhaps they might be doing better than we are.

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