Keith Swanick (Fianna Fail) | Oireachtas source

I welcome all the contributions. I will start with Dr. O'Connor's comments, which I agree totally with. I worked in Blanchardstown hospital as a senior registrar under Mr. Derek Barton a few years ago, and I know first hand the pressure that doctors are under. Indeed, in my time, the recess room was located in a prefabricated building to the side of the emergency department. I also note the increase in attendances of 8.7% in the last year, and that 25% of these people require admission. Longer delays often lead to poor outcomes, with people failing to return to their pre-admission state.

Opening community beds outside of the nine to five model that we have currently was mentioned. Ms King also touched on the fact that 150 acute beds have been closed and hundreds of long-term public beds have closed. I know first hand from my own experience as I run a small community hospital in Belmullet, and we have had bed closures due to staff shortages. We need to look at the role of the community hospital network in this country. It should not be seen as a relic of a bygone era. I am not talking about nursing homes here. I am talking about community and district hospitals. They truly alleviate the pressures of secondary care insofar as GPs can admit directly to the community hospital for problems such as urinary tract infections and chest infections which do not require admission to acute hospitals, thus preventing admissions to the acute sector. They also facilitate discharges from the acute hospitals, for example, in the case of patients who perhaps after having had a hip replacement can be transferred back to a community hospital post-op and have their rehabilitation carried out with the help of a community physiotherapist. That frees up a bed, which allows an emergency department patient to move into that bed. There is another nuance here in that the community hospital network could act as an interface between the fair deal system and the acute sector. If someone is in an acute bed and applies for the fair deal scheme to enter a nursing home, he or she could be waiting ten to 12 weeks in that acute bed. There is nothing stopping us from transferring that patient to a community facility in the interim, prior to being transferred into a nursing home. I would value any thoughts on that.

On what Ms Doherty said concerning some of the suggestions for improvements and that GP services must be more effective, I am a GP in a rural area and I totally agree with her. On one day over Christmas my two practice nurses and I saw 141 patients, and we referred one patient to the emergency department. That is because I have two practice nurses, who are both excellent. They are both prescribers. However, the system we have at the moment is that the HSE will fund one practice nurse per general practitioner which is insufficient. We have a shortage of GPs. Practice nurses are highly skilled and can carry out many of the roles a GP does. We should look at funding more practice nurses for general practices, especially in rural locations. I am 50 miles away from my local emergency department so I cannot be referring everything to the emergency department so we deal with it in the surgery.

On the Institute of Community Health Nursing, I am very supportive of that group. I had on a Commencement debate today and I asked the Minister for Health to look at the funding for it.

They do terrific work and their client base is the community so we should value their role. I would appreciate Dr. O'Conor's views on this and the other matters I have raised.