Michael Harty (Clare, Independent) | Oireachtas source

I thank the Minister. Before I bring in Deputy Durkan, I have a few observations and comments. The document notes an underspend in primary care of several million and an overspend in the hospital service of €104 million. I think these items are related. There is evidence to show that for every €1 spent in primary care, one will save €5 in secondary and tertiary care. If we continue to underfund primary care, the natural result will be that we will end up with a more expensive hospital system. There is evidence that the attendance rate for patients at emergency departments is 40% less than in the UK. That is because we still have, for the most part, a same-day general practice service. In the general practice service in England, one can wait from ten days to three weeks to see a GP and that leads to huge amounts of work being transferred to the hospital service. In Ireland, we still have a same-day service for general practice but it is dwindling because we resourcing for primary care has been reduced and there is a huge shortage of GPs. The HSE maintains that there are only 17 or 18 vacancies at any particular time but many practices are being lost and amalgamated. In addition, services are being moved further away from patients, particularly in rural areas. The underspend in primary care has a natural consequence which, I believe, is the overspend on the hospital service. I would like the Minister to comment on that.

There has been a reduction in the funding to public hospitals from private health insurance. Ireland is unique in that its public hospital system is dependent on private health insurance coming to fund its services. The reduction in private health insurance income to our public hospitals must be having a service impact and I think that probably leads to our waiting lists being extended.

There is an issue with the number of patients seen by nurses. I presume that refers to the number of public health nurses that are available. There is huge pressure on public health nurses. There has been a 28% reduction in the number of patients seeing nurses. Is that a reflection of our difficulties in retaining and recruiting public health nurses?

Senator Dolan referred to respite care. There was a reduction of 10,000 in the number of respite nights in the first half of this year. Will the Minister comment on that? It is a huge reduction in respite care for people with disabilities.

Comments were made earlier on the targets for inpatient, outpatient and day-case procedures. Are those targets realistic? I am of the view that they are very modest and that the problem is that they are not being met. They are not being met because of bed shortages and recruitment issues. Perhaps the Minister will comment on that.

Some hospitals have good trolley numbers and others do not. I think this relates to the catchment area of those hospitals. Areas where there has been reconfiguration - such as Ennis and Nenagh, which lost acute services that were moved to Limerick, Drogheda, where associated hospitals were reconfigured, and Galway, where hospitals lost their acute services - have the highest trolley counts. That is a direct reflection of how reconfiguration was mismanaged. It also reflects position regarding catchment areas. For example, the catchment area in the mid-west is home to approximately 440,000 people whereas the catchment areas of some Dublin hospitals may not be that size and, consequently, they may not have the same pressure on their services.

We have failed to reach targets for breast, lung and prostate cancer. We have failed to meet the radiotherapy targets. This must be a reflection of the recruitment and retention of staff as well as bed capacity. Soon we will only be able to provide acute care and cancer care because of the lack of beds for patients seeking elective procedures. There is significant pressure on the accident and emergency department of acute hospitals. Patients who attend at accident and emergency departments are being admitted to beds which would normally be reserved for elective admissions. I would like to hear the Minister's comments on that.

I have information that most of the money allocated to the National Treatment Purchase Fund is being spent on day cases rather than on inpatient procedures such as hip or knee replacements or procedures that would require a prolonged stay in hospital. Care authorisation notices for public hospitals were issued to 2,496 patients, but only 104 patients had a procedure as an inpatient, which is 0.4% of those who had been offered a service. In the case of people whose needs were outsourced to private hospitals, some 5,295 care authorisation notices issued, yet only 946 patients, which is 18% of cases, had their surgery completed.

In regard to child and adolescent mental health services, CAMHS, 32% of adolescents are still being admitted to adult institutions for care. That is quite an extraordinary figure. Perhaps the Minister will comment on it.

Deputy Alan Kelly raised the issue of St. Joseph's Hospital in Ennis. I know it is sub judice. St. Joseph's is an old hospital and issues arise because it cannot provide services that could be provided in a new hospital. There is a proposal to build a 50 bed unit in St. Joseph's to replace the existing beds but the planning, design, procurement and building of such a facility is a four-year process. That is too long for an essential service. Will the Minister comment on those observations and questions?