Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the witnesses. We have had many reports and observations from professional bodies and research groups about the demands that will be placed on the health service because of demographic changes, the ageing profile and the complexities in society with regard to illnesses, diseases and the levels of and increased sophistication of prevention that allow people to live longer. We all know that huge demands will be placed on health services in the coming years. The key question from our perspective is how we plan for that, how we implement the plan itself and the costs of it. On Deputy O'Reilly's question, it is often the case that we can, with some degree of accuracy, predict what we require in capital development projects, including how many beds we need, how many hospitals or how many kilometres of road or whatever other infrastructure capital is required for. We seem to have an inability to assess our human capital requirements, primarily the skill sets required for the economy and, in this context, the health services too. I assume that because of the research done by the Economic and Social Research Institute, ESRI, by Dr. Wren, as well as by Professor O'Dowd, that we should have some window into the future showing what specialties we most need in the years ahead. I assume geriatricians and similar specialties would be a key component in any future planning but we do not seem to be doing that in advance. I find that we consistently wake up with skill shortages on a continual basis. Do we need to do more work on that or is there enough evidence to tell us exactly what we should be doing as policy makers with professional bodies and oversight bodies to establish additional capacity in training and changing existing training programmes and regimes to allow for that projected change in demand in the health service in the years ahead?

Everybody has accepted that we should move from hospital-centric care to primary care and community care. It is a huge leap of faith because we will have a major problem if it does not work. We will have spent a lot of money to develop primary care but if we still end up with a huge drag into the hospital system, then we will have the worst of both worlds since our primary care and community care system will not be stopping the flow of patients into the hospital system. Has any country moved from the disparate, broken type of system that we have with primary care and community care, with no joined-up thinking or interconnecting, to having a very successful system? Is there any country of comparable size or geographic make-up that has successfully made or at least started the journey to success in developing a proper primary care and community care infrastructure?

With regard to diagnostics, we have to accept that the idea that a GP has to refer a person to an emergency department to get an X-ray or MRI scan is just bizarre. I cannot understand why it happens frequently. It happens all the time in Cork, where one sees people going to emergency departments with their letters and it is primarily because a doctor cannot get a diagnosis in a reasonable time and so refers a patient to the emergency department.

That is a huge waste of resources and an imposition not alone on patients but also on emergency departments, which are the sections of the hospital system that are under the most stress.

Where should diagnostics be located and what should be available to general practitioners, GPs, in terms of being able to refer diagnostics directly? I note that there is strong collaboration between GPs and consultants in areas such as cardiology, but it does not seem to be as effective in other specialties. Is there any blueprint in that regard or what should be done to allow and facilitate GPs to refer for diagnostics directly? What increase in infrastructural capacity would be needed? Must such facilities be attached to hospitals, could they be stand-alone units or at what level and where should they be provided?

As regard nurses and nurse specialists, there is no doubt we are moving to subspecialties in all key areas, including nursing. Nurses have been underutilised and much abused in Irish health care systems in the sense that they are highly skilled, very flexible and, as was pointed out, consistently strive to professionalise themselves further in terms of education. Although they are at the centre of delivery of care, that is not the case in regard to the decision-making process, and that should be looked at.

I do not raise this point because a pharmacist is a member of the committee. I do not understand why highly qualified pharmacists leave college after seven years but are given no key role in the health services in terms of the professionalism they bring to it. There is a pharmacy in almost every town, village and street in the country, but GP services are bursting at the seams and are unable to see patients on a same day basis. The role of community pharmacists is not fully utilised and could complement GPs and GP services. Pharmacists cannot diagnose continually but could do so for minor ailments. That people have to go to GPs regularly and have to do so consistently to renew prescriptions should be looked at. In my six or seven years observing the situation in terms of health care as a spokesperson for health, I note a continuing huge resistance to change by professionals in respect of matters that may lead to others encroaching upon their areas. I invite observations in that regard.