Michael Harty (Clare, Independent) | Oireachtas source

I thank Professor Keane. I have been watching his career for many years.

I wish to refer back to some of the themes mentioned by the professor at the beginning of his contribution. He spoke about talking to people who know what the problem is and that is what this committee is all about. We are trying to identify the problem. In the professor's view, what is the problem and where should we start to change our health service? The second theme referred to by Professor Keane was building trust, especially between competing sections in the health service. Is logic and good data enough to convince people to change and to trust each other?

Professor Keane also referred to communication and communicating change. We have heard many witnesses over the past number of weeks suggesting that we orientate our health service in a different way, particularly towards community and primary care in the context of chronic disease management and changing demographics, which mean that we will have an increasing number of elderly patients. How would Professor Keane suggest that we go about reorientating our health service? I also seek his views on how we would better integrate primary and secondary care, which is one of the problems we have identified.

On the issue of the generalist versus the specialist, the only generalists left in the Irish health service are GPs and geriatricians. Everybody else is a specialist and as our population ages, we will have a huge amount of multi-morbidity which requires a holistic rather than a specialist approach. I ask for the professor's comments in that regard.