Alan Kelly (Tipperary, Labour) | Oireachtas source

I thank the witnesses for their presentations. It is the first time I ever said this and I do a lot of committee work but I do not think there was anything I disagreed with. In this Oireachtas there are two health committees, the normal health committee chaired by Deputy Harty and this committee under the chairmanship of Deputy Shortall. This is a once in a generation, possibly once in a lifetime, opportunity to finally sort out the health service. Ultimately it is an ideological debate.

The report we will produce, on which we have a timeline, will be fairly high level. It may have some indications with regard to a plan, which I will deal with, but it will be fairly high level. I hope I am not speaking out of turn but I believe most of us will come to a consensus in terms of what we will decide about a single tier system where services are free at the point of delivery but we will have to deal with the questions, challenges and pressures that will arise in terms of how we will fund that and the consequences of saying what was just said about private health insurance, for instance. That is an issue on which we will have to bring the public with us, and the witnesses in terms of supporting it, because as I said in the Dáil last week, if we are ever to sort out the health service, morally, we cannot allow what is happening to continue where an elderly woman can go into a public emergency department and wait on a trolley for two or three days to be admitted when 100 yd. down the road an executive of a company can go into a private version of the same hospital on the one campus and be treated immediately. That is just not equitable in 2016.

With regard to how we do this, my colleague spoke about the big bang approach. I agree with Mr. Doran that we cannot take a big bang approach. We have a mandate for ten years but we should not get too stuck in that. Over the coming years we will have to phase in the changes with regard to this ideological thought in terms of how we will turn that around, phase out the contracts Mr. Doran spoke about, ensure there is adequate funding and prioritise the different areas. I can see an avalanche coming towards us with regard to care of the elderly. Given that soliloquy, my first question is on the process we will go through in producing a report on the future of health care over the next ten or 15 years. In terms of stopping that ship, turning it around and facing it in the right direction, what areas do the witnesses believe we should prioritise across the health service, given that we will have written a report for which I hope there will be political support on the basis of what I just said. Which areas do we prioritise, in what order and to what timeline? It is a difficult question but I would appreciate an answer to it.

Second, I presume that turning around primary care is an absolute priority given the costs associated with treating elderly people in acute care versus treating them in their homes, etc. How quickly could we have the capacity, working with the unions' members, to turn that around and create a primary care service across the country that is consistent throughout all its services? We know what we want but if that was a priority, in what timeframe could we turn that around?

I have two final questions. First, we spoke about restructuring fatigue, seven hospital groups, nine community health organisations, etc. That does not make sense to me. I had a discussion in Clonmel recently with one of the authors and I told him it did not make sense to me. There is restructuring fatigue. How can we bite through that, so to speak? It is not just about this committee producing a report stating that we need this structure because I am not sure anyone would believe that. How can we change the discourse on that to ensure we bring people with us on it? There will be organisational change but it should not be just a top-down approach.

I would like a brief answer to my final question, which concerns the witnesses' members. We had a presentation some weeks ago on the use of technology to facilitate the witnesses' members with regard to their work. How bad is that? From what I see, it is fairly bad. With regard to facilitating the work the witnesses' members have to do on the ground, all of us are aware of the issues to do with staffing but we also know that those members are not being facilitated through archaic systems that are in place.