Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I will go through questions quickly because of time constraints. There is the issue of private health care funding and targets being set. Will the witnesses elaborate on that, although it has been discussed already in terms of targets? Deputy O'Reilly referred to this. If the hospitals are full and running a big budget deficit, to be honest any accountant would say they should be filled with people who will pay for that bed through private health insurance. Where is the incentive not to do so? In other words, where is the incentive to treat people purely on a list basis? To be honest, no list comes through to an accident and emergency department and it is just about who presents there. I am quite sure decisions can be made as to whether these people should be referred further up the hospital or back to the community. Is there any incentive to refer people who may potentially contribute to the hospital through payment by private health insurance? Does it exist at that point to divert people to the hospital or send them home? There have been cases of people being questioned in accident and emergency departments about private health insurance and I have documentary evidence on that. I also have some of that from insurance companies which have informed me that people are being questioned in accident and emergency departments, leading to people being corralled up the hospital if they are private and, more than likely, home if they are not.

There is the broader issue of hospital groups. I have been the spokesperson for my party for six years on health and I am still unsure what hospital groups are and where we are going. If anybody around the table could tell me, I would be delighted. We were to establish a hospital group system and move to trusts that would compete with one another. This was based on the principle of the universal health insurance model, and although that has been scrapped, we have hospital groups up and running and in some cases boards are telling me they have some form of authority while others tell me there is no authority and they run, cap in hand, to the HSE the whole time. Are there varying degrees of autonomy between the various hospital groups?

Mr. Power referred to information technology, IT, systems. These are observations as opposed to criticisms. We have not exactly covered ourselves in glory with IT systems in this country, to be upfront about it. That is not just in the health area but across broader systems. While we have a wonderful software and IT industry, we seem to be incapable of transferring that as efficiently as we should into the Civil Service and public service. Who oversees the IT roll-out in the various hospital groups? Is it fully centralised? Mr. Power indicated there was a design for an IT system in the Saolta group but why is it not being designed for every other group if it is that good?

Neither the HSE nor the groups can borrow. Is all the equipment in every hospital owned by the HSE? I am referring to the likes of MRI, PET and CT scanners, which are high-tech equipment. Would a leasing system not be much better? Could we lease the equipment like any functioning commercial body? We could lease them from Siemens or other manufacturers. There could be contracts in place regarding replacements, repairs and maintenance. That just does not seem to be the case. I know a hospital waiting for a part costing €1.3 million but it cannot be purchased because the money is not available. Women have to travel from Cork to Dublin as a result for treatment because the piece of equipment is broken.

Could we be in any way imaginative on that? What are the views of the witnesses as representatives of hospital groups in terms of at least having the autonomy to enter into long-term lease arrangements with hi-tech equipment suppliers on a commercial basis, including maintenance and replacement?

If somebody mentions Beaumont to me, I think of a fine hospital but also of seven ambulances outside the door. When I hear "Our Lady of Lourdes", I think of queues and when I hear "Limerick", I think of chaos in the emergency department. It is the same in Galway. Let us be honest; that is what the public thinks. While it is sometimes propagated for political purposes, it is the factual reality for patients every day. What supports are the groups getting from the HSE nationally to assess the types of patients that are presenting? We have had evidence from Mr. O'Brien himself pointing out that a lot of those who present at emergency departments should not be there in the first place. Are the witnesses getting any support from the HSE nationally to address that particular deficiency in community services and the primary care setting, to assess what patients are coming in, why they are coming in, who should not be there in the first place and what service deficiencies force them to end up in acute hospital emergency department settings? While the witnesses have probably discussed it already, I would like to hear some views on that.

We have always criticised the HSE nationally for its silo thinking. There is primary care, community care, acute hospitals and all the various silos in it. I am beginning to detect that this is symptomatic of problems within some of the groups as well. There is too much silo thinking funnelling down from the same sort of structure at national level and there is no clear co-operation between acute hospitals and community care, primary care or step-down facilities to work that in a basic, coherent way.