Michael Harty (Clare, Independent) | Oireachtas source

I thank Mr. O'Brien, Mr. Woods and Mr. Mitchell for coming before the committee again to see us. I will try to be brief in my comments and questions. The terms of reference of this committee are to provide a single-tier system that provides services in a timely manner based on need rather than ability to pay, which effectively means patient-centred care. In our planning, patient-centred care tends to be forgotten about, unlike structures and governance. My questions therefore concern patient-centred care.

First, what do the witnesses think will trigger the transfer from hospital-centred care to primary-centred care? We have a capacity problem in general practice but also with public health nurses, therapists and psychologists. A range of personnel make up primary care, not just general practitioners.

Second, Mr. O'Brien mentioned transitional funding, which seems to be absolutely essential in any transformation programme. How would such transitional funding be targeted?

Third, there is a problem with integration of GP and hospital services and there is a gap between the two. The trigger of the transfer of people from general practice to hospital services tends to be immediate. There is no transition between hospital and GP services. I would like Mr. O'Brien to comment on how this transition could be filled.

There is a problem with governance in our hospitals and within the hospital groups, and there is very little GP input into governance in the hospital groups, which leads to much frustration among general practitioners. There is also very deep frustration among consultants in the hospital groups that their voice is not heard. There is a gap in the governance between what it is intended to do and how it is delivered.

Finally, regarding bed capacity, I believe 600 beds are occupied by people who are on delayed discharges. This is a huge rate of bed occupancy which does not fulfil an acute need. Perhaps Mr. O'Brien could comment on how delayed discharges and transfer to community services could be bridged. There has been a huge withdrawal of or reduction in publicly-funded chronic care, which has been transferred to privately-funded chronic care, and the gap in this regard needs to be addressed. Publicly-funded chronic care is very important but seems to be decreasing rather than increasing.