Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I welcome our guests and thank them for their interesting presentations. Going back to this morning's discussion, a medical consultant had previously intoned to me that medical economists were the cause of the problem, and he may not be wrong. I recall a different era when it was fashionable to say that we wanted fewer beds. I remember raising that question during the design stage of a hospital and a fairly long argument went on about the issue, an exercise about which I could not see the purpose, but the theory put forward was that people would be staying in beds for shorter periods. That did not work either. There is something in what my consultant friend said and was right about. There is a problem that needs to be dealt with and I agree entirely. We do need more beds.

I had occasion to be in a hospital in recent years and found beds in every corridor, in the waiting areas and at the reception area, with people being fed, bloods being taken and all at the same time and in the same place. I asked why this was happening when a couple of wards were decommissioned around the corner. I was told that it was less expensive to maintain the beds in the corridors. My conclusion was to ask whether it would not be cheaper, or almost free, to have the beds out in the car park. Pardon me for being cynical but these questions must be asked from time to time. My conclusion remains that we need extra accommodation and we need to have it active, available and ready for emergencies. The question then arises about how to utilise the spare capacity in ordinary time. If we have the adequate capacity to meet the emergencies, and it must be made available, then the hospitals must have some way to deploy that spare capacity in ordinary time.

Will the witnesses explain how they deal with the recruitment issue? For instance, are medical services people paid less in Ireland than in other jurisdictions such as the UK, France or the Middle East, which is the place everybody wants to go to nowadays? Are we paying enough or are we paying less? What is the comparison between rates of pay in the UK and Ireland, for example, for nurses, consultants and doctors, and how do we address the issues emerging from that?

The operation of the fair deal scheme is another issue that drives me up the wall. One of the things that bugs me relates to geriatric care, as my colleague Deputy Kelleher has pointed out. This care is delivered by way of nursing homes and by public, old-fashioned community hospitals. On the one hand we have the Health Information and Quality Authority, HIQA, decommissioning public facilities and reducing bed and ward capacity in accordance with some mysterious policy. I do not know if this makes any difference to some patients. Generally speaking, elderly patients in a nursing home like to be able to talk to each other, their ward neighbours or the people down the corridor. I wonder what exactly the cause is and where the inspiration came from that money should be spent in subdividing wards to create less space at a time when more space is required. It bugs me that in the assessment used by the fair deal scheme, which I understand is being reviewed at the moment, the family home of the person is taken into account, even where the family home is not available for a particular reason. Maybe a person with a disability or a long-term illness has an entitlement to the family home for many years to come or ad infinitum, but the home is still taken into account in the assessment of the means of the person concerned, ultimately making it more difficult for the person to gain access to the scheme and so to leave hospital. That is a factor in the blockage in step-down facilities.

In looking at costs and comparisons with EU figures for consultant and GP ratios, I know that Ireland, for example, does not have a similar GP system to Germany as they operate different systems. In the witnesses' opinion, which is the best system operating now and how can Ireland aspire to it? We heard about the Dutch, French and Canadian systems - some magical system somewhere - that is obviously better than ours. Yet Ireland has a reasonably good system. Once upon a time, not so many years ago, a gentleman in this House said that in the days when we had no money there were lots and lots of beds and one could gain access to a hospital anytime one wished. Admittedly, it is true that we had a smaller population then. If the population is growing, however, and it has become fashionable to reduce the number of hospital beds, where do the two meet? What was the purpose of that exercise?

There is something I still cannot understand. I know there are many primary care centres throughout the State now. There should be some indication as to the extent of their intervention in alleviating the overcrowding at accident and emergency departments and in the system generally. How are they operating and gelling into the system? How are they interlinking with the community care system on one side and with the general hospital services on the other side? Are the primary care centres doing the job intended for them? We were informed last week that these centres are state of the art. I am delighted to hear that but we must remember that they are structural edifices within the system and if they do not contribute to alleviating the burden on the community care and general hospital services systems, of which they are part, then I would like to know why the primary care centres do not relieve that burden. Somebody somewhere must be able to tell us this. I have raised questions in the House and with people before this committee many times about this and I have not yet had an answer. There is, however, an answer to be had. If our health services system is to work, we should see how it works well here. I remember a similar situation in Northern Ireland many years ago when it was quite possible to deal with emergencies in what was called a health centre at the time but which was effectively a primary care centre. They were quite capable of dealing with emergencies without any difficulty at all.

What exactly are we doing?

I wish to comment on the cost of medicines. It is only part of the system but the cost affects the extent to which funds are available to run the health services. I have always held the view that we should procure medicines at an EU level where there is a massive market. Ireland is in the Single Market and membership is supposed to carry clout and weight. Modern technology allows countries to transfer money and debt across borders very quickly. I cannot understand why we cannot transmit the necessary messages to avail of the buying power of 500 million people as it carries must greater clout than the Irish population of 4.5 million.