Oireachtas Joint and Select Committees

Wednesday, 22 March 2017

Select Committee on the Future of Healthcare

Health Service Reform: Minister for Health

9:00 am

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

I welcome the Minister and thank him for his input and comments.

I have no ideological hang-up about the private and public health sector. I am a strong supporter of the public health sector and hope that that is part and parcel of what we require in this country. The public and private sector should complement each other rather than occupy each other's space. The input of the clinicians has been referred to as a cause of frustration. We have often talked about having an accountable, democratic forum where decisions are made and there is accountability. That is missing from the system that has been there for the past number of years, and that has to change. I believe the proper structure should comprise about four regional authorities which are directly accountable to the Department of Health and the Minister, who is in turn accountable to the Houses of the Oireachtas. That line of responsibility and accountability will remove many gripes taking place at present which cannot be removed or dealt with otherwise.

Health education has been referred to as a contributory element in the delivery of a good health service. I agree entirely with that. A much greater emphasis needs to be placed on health education, good health policies in schools with children and identification of the various health issues likely to emerge in the future long before it becomes necessary to refer them to a hospital.

I think we need something else as well. Living within our means with regard to the delivery of all services is important. At election time, we politicians tend to succumb to promising what we would like to deliver. We would all like to deliver everything but unfortunately we cannot afford to deliver everything. Therein lies the problem that emerges some time later when we take from what we already have in place in order to provide for something that we cannot afford without making the necessary provisions. It goes on all the time. We all contribute to that and that needs to stop.

The Minister referred to beds not being the entire answer. I am not 100% sure about that and I go back a long way on that. I heard this 20 years ago and 30 years ago throughout the health service. There was a shift away from beds in the UK, which said that no beds were required and to strip the number of beds down. We did that in this country, and yet every time a constituent comes to us, as politicians, inquiring as to when he or she is likely to get service, we ask why that person cannot get service and what the problem is. Has his or her consultant or GP gone on holidays, or is there a lack of beds? Lack of beds comes up again and again, and people say that their consultants cannot find beds. There has to be some reason that is the case, and unless we deal with that, we are wasting our time, because we are going to have a blockage in the system and it is going to hold up someone else.

Let us be careful about primary care. It costs money as well and the critical issue is the extent to which it is going to take money from other parts of the system. We need to put more money into it. There is no doubt about that. We need to have it along with the rest of the system and working in conjunction with it. As has been discussed by the committee, the linking up of the hospital system with regional authorities and dovetailing one to the other, from primary care to regional authorities, is an excellent idea.

I want to make a point on a matter I have heard a few times recently. The Committee of Public Accounts has no function relating to policy. It is specifically excluded from infringing on that area. We should never forget that. It deals with value for money and efficient spending of resources made available. It is not a policy-making body and has nothing to do with that.

We have the opportunity to reinvigorate the health services in line with the requirements of now and the future. We have previously been providing health services in line with what was sufficient ten or 15 years ago.

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