Simon Harris (Wicklow, Fine Gael) | Oireachtas source

Maybe they are. The Deputy is right about predictability and avoidability. I will not play a word game and confuse everybody. The point I am trying to make is that everybody knows. If the Deputy was sitting in the chair I am in now, we would all know the pressures our hospitals come under. They are pressures our hospitals are always under but we know that tipping point is hit every January. I tried, my predecessors tried and my successors, in time, will try to handle it. Unless we take some big, fundamental actions, that will be repeated each year. I genuinely believe that the capacity review is a big part of that. There is also the issue of trying to keep people out of hospitals in the first place. Sometimes, in January, there is a bit of misinformed commentary. If people are on a hospital trolley, a clinical decision has been made that those people need to be admitted to an acute hospital. It is not a case of people who could go to see a GP, take two antibiotics, and be home in bed, resting. The bigger question is, if those people had access to chronic disease management in the community and so on whether we could have avoided that acute incident ever happening. That is where I think the GP contract has a role to play.

I am sure our colleague, the Minister of State, Deputy Daly, would be delighted to answer the question about Bandon District Hospital if he was here but he is not so I will give it a go. The Deputy is right. I visited Bandon District Hospital and it seems to me to be a wonderful, very special place. I was struck by the warmth of the staff and the patients. I am conscious that there are issues before the Labour Court and it would be inappropriate of me to comment but I hear clearly from Deputy Murphy O'Mahony about the importance of the facility, specifically the respite facility, and the burden that the lack of the facility is placing on people in the Bandon area. My Department and the HSE are watching developments with interest.

The director general might want to comment on the waiting list issue in a moment. I am not a doctor and the Deputy pointed out that she is not one either. The decision for people to be removed from waiting lists who no longer need to be on one is a clinical one. There is no edict, nor should there ever be one, that a person is taken off a list unless a clinician believes that there is a better way to care for a person. If the Deputy wishes to send the details of that individual case to the HSE, I am sure it will look at it.

A GP card for carers requires legislation. I said it would come in quarter two of this year so I expect we can have this in place by summer. Let us work together on that to try to get the legislation passed. We have a very busy legislative agenda ahead, as we all know, from my Department in the coming weeks. I would like to get that passed and in place by the summer. Supports for rural GP practices, building on what my predecessor, the now Taoiseach, Deputy Varadkar, did, will be looked at in the context of the GP contract.

Deputy Durkan rightly makes the point, as many of my colleagues also rightly make, that we are among the highest spenders on health care in the OECD. Even when one strips out the proportion of private health care included in that figure, we are still at the high spending end of that league table at OECD level.

We have to look at what we are spending the money on. I have previously used the analogy at this Committee of an old car which can be terribly expensive to run. A neighbour up the road can have a newer, flashier car which is actually cheaper to keep on the road. There is an issue here about the system we are pumping the money into. It is no disrespect to the system, but politicians and HSE management have acknowledged that it has to be reformed and changed. Patients are being treated in more high-cost locations - places they would rather not be - than is the case in other jurisdictions.

The point about people on trolleys is important. We have to remember that we are talking about people and not get lost in figures. The people on trolleys are those who clinicians have decided need to be in hospital. The reason they are on a trolley rather than a bed is because there is not enough bed capacity in that hospital. That is the straightforward part of the answer. The more complex but equally important part relates to the possibility of making reforms in the community health sector and keeping those people well and living in the community so that they do not have to come to the hospital in the first instance. That relates to some of what Deputy Kelleher referred to in terms of nursing homes. It also refers to things such as the diabetes cycle of care and how we look after people with asthma and chronic diseases in general. These have to be key priorities for us if we are to invest more in primary care. We know that there is a benefit in that regard.

The Deputies spoke about primary care centres. We have built a very good primary care infrastructure now. We are still building it; I am opening another centre in Limerick on Monday and there are a number of them coming on stream in the coming weeks and months. That is good. The State has invested a substantial amount in primary care centres. The conversation now has to move on to what is in those centres. These centres require staff and diagnostics. I opened a primary care centre in Castlebar recently and the X-ray and ultrasound machines are now in situ there. Patients who would have had to go to Mayo University Hospital are now having their X-rays and ultrasound examinations done under the governance of the hospital but under the direction of the primary care centre. That has had a very positive impact on those lists. We have to investigate how many more primary care centres we implement that system in. We have plans for a number of them in that regard.

I agree that we need extra beds by 2031. The evidence also shows that we need a number of the beds now.

We should acknowledge that activity based funding has given us a greater sense of what we are spending money on and what we are getting in return. We have to look at that in terms of the community.

I am aware of the issue concerning Crooksling nursing home. I look forward to visiting it in the near future. We certainly should not be reducing capacity anywhere. When a facility is being decommissioned it should be replaced by a facility with not just the same amount of beds but more. We also have to look at how we keep those facilities for the use of older people. A local group has a number of ideas in that regard, and I am aware that the HSE in South Dublin County Council is engaging on that as well.