Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I welcome the witnesses and congratulate the Minister, Deputy Harris. I am happy he is still Minister for Health. I note from his statement he has learned the value of using the available expertise to inform solutions, which is good to see. I also welcome the Ministers of State, Deputies Byrne and Finian McGrath, and congratulate the Minister of State, Deputy Jim Daly, on his appointment.

The Minister's opening statement referred to the increase in the number of consultants to support service delivery and the progression of compliance with the European working time directive. Has the increase in consultant numbers been eaten up? Is there a net gain in working hours or is it simply the case that we cannot have consultants working 70 hours a week? From memory, I understand the European working time directive limits the working week to 48.5 hours. Are we just complying with employment law or has there been an impact on hours worked and the services delivered to patients? I seek some information on that.

Is there any good news in respect of the recruitment of nurses? We repeatedly refer to consultants but we all know that health care necessitates a team approach and nurses are vital in the delivery of services in Ireland.

The Minister, Deputy Harris, and Mr. O'Brien referred to primary care. I understand Mr. O'Brien referred to a 34% increase in primary care referrals. Is there an impact on the demand on acute services, taking demographics into account? Is increased activity in the primary care setting reducing pressure on acute hospital settings? Are we transferring work or providing better care to certain people? Are we layering on more types of care and still allowing a cohort of people to languish? What is the impact of the movement of care on people's lives?

Mr. O'Brien provided great information on scoliosis treatment and the four-month target. Are there data to show any other child patient cohort has suffered as a result of this improvement? Has the diversion of the resources into scoliosis treatment left children with, for example, cancer, worse off? Have others suffered?

I refer to the reduced rate of teen suicide. My initial instinct was this was a result of the environment and economy rather than interventions. Perhaps services in the community have had an impact, rather than the economy. I would not like to think we are attributing success rates to something the HSE may have had nothing to do with.

Does the Minister have an update on the National Maternity Hospital? Is an update available on the operation of crisis pregnancy agencies and the type of information most people think is not suitable for vulnerable women in such places? I ask the Minister to comment on the female who was sectioned, who, I believe, is under 18 years of age and was forced to become a mother without wanting to become a parent. Can the Minister update us on anything regarding that case?

The Minister will receive a report from the Chair of this committee on the national maternity strategy implementation, which we discussed before the Minister came to the meeting. I do not want to ruin the surprise, but the first line of that report refers to 20-week scans. We listened to Professor Kenny from Cork who spoke about what I can only describe as the rationing of 20-week scans. The scans are being performed on women who are more likely to have a child with a defect. From memory, I understand one a week is provided to the non-high-risk group. A women who is 25 years of age and gives birth in Sligo, for example, rather than one of the Dublin teaching hospitals, may not have a scan.

Children are being born with undiagnosed birth defects. If those defects were diagnosed at a 20-week scan they could have received better treatment. They may have better outcomes if dealt with in a teaching hospital. It is very concerning that children who, along with the families and extended families, would have had better outcomes are being delivered in hospitals without staff having the correct information. Is there any update on the provision of 20-week scans? We seem to be an outlier compared to the rest of Europe.

The Minister of State, Deputy Byrne, is new to the area of health promotion. She probably heard I am obsessed with the HPV vaccine. There was a catch-up programme. Is there any information on the figures in terms of herd immunity?

In the context of the Sláintecare report, perhaps Mr. Breslin or someone from the Department could provide members with information on the alignment of hospital groups, community health organisations, regional health organisations and other matters we have discussed over the past year in terms of whether we can quantify results. We need defined populations and we need to know with what we are dealing. I am sure the witnesses are sick of listening to me going on about that but we have to keep going.

I do not want to overdo it on the couple who were separated in a nursing home but the case involved common sense and compassion. If the system involves an algorithm, and somebody inputted data into a computer and it said "No", we could blame the computer and algorithm. Human beings with hearts and pulses are making decisions. It was not a very difficult decision. It could not have been difficult to accommodate the couple. Who makes the decisions and how can they not tick the right boxes? It would make one wonder. Perhaps we would be better off with a computer that said "No" as then the file could be examined. Clearly, the human beings involved in the system are not able to do their job right if a vulnerable couple had to fight for the flexibility to allow compassion to be applied to their case.