John Dolan (Independent) | Oireachtas source

I thank the representatives of the three organisations, whose input has been helpful. It is quite clear after two hours of questions, observations and comments that this is a massive issue which we have to work our way through. We are here to speak about issues related to general practice manpower and capacity and a properly functioning primary care service. Clearly, the contract and from where the money comes must be part of the discussion, but it must go beyond them.

Representatives of two of the three organisations spoke in their initial presentations about chronic conditions, illnesses and diseases and the role of the GP. I want to focus on this issue, in particular. My particular interest throughout my working life has been people with disabilities and meeting mental health needs. I have worked with the entire gamut of organisations. People with chronic conditions do not account for the majority of the population but they certainly account for the majority of users of the system. Huge improvements have occurred in the past two decades in the longevity of people's lives. Morbidity is one of the legacies as regards what happens to people who do not die earlier, to put it as crudely as possible. I have several questions, but I will triage them and keep them brief.

All of us - the joint committee and everyone else with an interest in the issue - must consider how the groups and organisations that support and represent people with a range of conditions can gain direct access to what we will try to fashion. This relates to the first question I will ask. Members will be aware that there are support organisations for people with particular conditions, for example, Alzheimer's disease, stroke or muscular dystrophy, and people may or may not know about these groups depending on whether they have an early diagnosis and so on. These organisations have a role to play. I wish to address the issue of self-management. In the past decade or thereabouts, I have seen people with certain conditions going through programmes independently and this has given them a better sense of control, ownership and leadership over the condition with which they and their families are struggling. Dr. Byrne spoke about passing down units of activity. In a sense, what I am speaking about is passing units of activity and partnership down to the person who has a chronic condition and his or her close advocates, for example, a family member. How can that become a richer part? We have many groups, some stronger and more competent than others, associated with various chronic conditions. These conditions are being diagnosed earlier and people are living longer. I ask witnesses to give their initial observations on that.

Will the witnesses name one or perhaps two actions, changes, developments or obstacles outside the health system that have an impact on health and welfare? We spoke about inside the health service but there are other parts of people's lives and public services that have a bearing on how fit, competent and supported people can be in dealing with various eventualities.