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

I welcome the interesting contributions. Deputy Kate O'Connell raised the issue of lease maintenance contracts for high-value and diagnostic equipment across the HSE. The new children's hospital will be in the frame of lease maintenance contracts. I do not know why it has not percolated beyond in terms of capital spend and capital investment in plant.

I would like to tease out hospital groups. There are various views as to whether they are coalescing properly with the CHOs. The HSE establishes a hospital group and gives it independence. Will there be any overarching national policy that will set down parameters for the hospital group in terms of the type of investment it will make and the services it will provide? For example, if all seven hospitals decide to do left hips very well, who will do the right hips? Will there be a national policy that will filter down to ensure we have adequate services in all specialties across the country and that we do not have unnecessary duplication? Given that we are giving the hospital groups independence and their own decision making processes and budgets, how can we ensure we have adequate cover, particularly for sub-specialties, across the country?

Mr. O'Brien said we needed to make a decisive shift from acute hospital settings to primary care. Probably one of the key issues in making this decisive shift will be negotiations around the GP contract and the delivery of chronic illness care in the community. What does Mr. O'Brien think would be necessary in the contract, without showing his negotiation hand? What are the broad parameters of what is required regarding the detail of the contract for chronic illness and manpower and manpower planning for this inevitable and decisive shift from acute to primary and community care?

We talk about our aging population and the demographic bulge that is evident a short time down the road. Yet, judging by our investment in geriatric services and specialties, we do not seem to be planning in accordance with what we know is going to happen in training, recruitment, retention, expanding training programmes to ensure we have sufficient capacity and manpower to deal with those challenges.

Do we need a division to oversee the roll-out of primary care, or should it be done by the hospital groups? How should we do it to ensure we get primary care running efficiently in tandem with the acute hospitals? Over the years, we, and everybody else who has examined health systems across the world, have consistently said primary care is the way health care should be delivered in the years ahead. Yet, the minute a budget adjustment is required, primary care always seems to be hit first, and then everything falls back on the acute hospital setting. We have strategies in place to deal with the winter initiative, such as cancellations of elective surgeries when there is overcrowding in hospitals. At what stage do we realise we cannot keep doing this and that primary care has to deal with the capacity issues in the acute hospital system?