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

I apologise for my late arrival but the traffic was hectic this morning.

I agree with the Chairman's observation on the need to ensure that adequate private health insurance patients are diverted towards the public hospital service. I had a recent case where a patient was refused access to the public hospital system because they had private health care insurance. That is the policy. The person opted for the public hospital because they had been there before, but because it was an emergency case and the person had private health insurance, access was refused. I do not think it is a good practice at all to refuse to admit private patients and I brought this case to the attention of the Minister privately.

The availability of hospital services has been the subject matter of discussion for as long as I have been around. It requires further attention. We need to look at glitches that cause hiccups in the system, backlogs in accident and emergency departments and long waiting times for admissions. We need to look at the extent to which the needs of those who present at accident and emergency departments as an emergency should have been met by admission as an inpatient or to day care. I also came across a situation very recently where a patient was being recycled through the accident and emergency department and discharged on more than one occasion to a rural hospital, instead of being admitted to hospital for the necessary procedure. This should not be happening. The staff in the accident and emergency department should be able to come to a conclusion that these patients are in severe pain and require urgent attention. There must be a reason that this care is not provided. We need to assess what impedes the flow through the system.

It was brought to my attention that a consultant who wishes to work in the public hospital system found that he could operate for the whole day in a private hospital whereas in a public hospital he could only perform two procedures because of the lack of theatre staff, an anaesthetist or some other personnel. There was some reason that he could not operate for the whole day. The Sláintecare programme will go down the tubes unless we can identify the cause of problems and remedy them. We need a trouble shooter in the system who can pinpoint what will go wrong long before it becomes obvious. I will not refer to the issue of scoliosis that was referred to already. Imagine what it is like to be disabled and to have to live in cramped conditions. Why was it not possible to identify the scale of those requiring treatment for scoliosis long before it became a public issue? We all heard about it at the same time. Those requiring treatment for scoliosis were in the system as they had been assessed as requiring urgent treatment. We need to conduct an audit of the deficiencies in the system in order to identify how we can intervene in a positive way to ensure that it meets the requirements of the patients as quickly as possible and in so far as possible.

Our health service is not the most poorly funded health service in Europe by a long shot. I am trying to avoid criticising the services directly. We tend to comment negatively on the GP, hospital, day care and accident and emergency services so that nobody wants to take up a GP practice when it becomes available for the simple reason that the system is being dumbed-down and there is no future in it. Nobody wants to take on a role where there is no future. That should be known to everybody. I am aware of a recent case where there was only one applicant for a job. If we do not address the problem, young professionals will seek to work in places where they do not have that hassle and also have to deal with the ancillary issues such as the cost of houses which are twice as expensive as elsewhere. The GP does not only have to pay for the practice, but also pay for a house.

Members have referred already to the fire fighting issues and the need to stamp out the crisises as they occur. We need to identify the causes instead of wasting our time fighting them. That is not a criticism of any person, but we need to take action.

If we are attempting to deal with the high cost of drugs in Ireland on our own, we will not succeed. It will not be solved on the basis of an amalgam of 13 or 14 EU members states applying an average price across member states. Effectively the major drug companies blackmail governments by feeding the drugs into the system in the first instance, and achieving patient satisfaction because the new drugs are a significant advance on what was available previously. Then the drug companies can demand a ransom figure to supply them.

The orphan drugs and ransom figures will be associated in future as it is what is happening. No single government across Europe will be able to address such a problem.

There is the question of agency staff, which has not been raised. I know, having been a member of a health board for some time, that there is always a need for some agency staff. However, the degree to which the system has become reliant on agency staff is now alarming, as are the costs associated with them. I realise locums and emergency staff must be paid more to fill needs at a particular time. However, the more we become reliant on those staff, the more expensive and less efficient the system becomes, with less patient satisfaction. The patient likes to know the person he or she is dealing with and that the same person is there all the time. The patient would immediately raise questions if a third person is introduced to the process and it suffers as a result.

There are a couple of other matters I will address before concluding. We have the ability to provide a good health service in this country and everyone is striving to do that. We need to recognise that we also need to achieve efficiencies in the system. I have my own views and the committee has heard them. The Health Service Executive, HSE, does not deliver and it is not suitable for the delivery of services throughout the country. There is no use referring us to the greater Manchester area because we have a comparable population and it should have the same type of service. That is not true as there is a vast geographical difference and many miles must be covered by people. Hence the difficulty in providing services to the rural areas to the extent we have come to expect.

We know that we have been able to provide services. Perhaps we were not able to do it as well as we would have liked but we were able do it. It was still possible to get emergency access, although I know that is still possible if one gets through the accident and emergency department process I spoke of. There are competing demands nowadays that we all recognise within Departments and between Departments. We know all that. If we are to look after the health care requirements of the community, we must be able to assure the people that the taxpayers' money being spent on the delivery of health services to the public is adequate to meet people's concerns and demands in future.