Colm Burke (Fine Gael) | Oireachtas source

I thank the witnesses for the very comprehensive overview and the report itself.

One of the problems I find with the healthcare sector, and I have been following it for ten to 12 years, is the time it takes to get change. On the one hand we have had change in the Irish health system in the past three years with an additional 11,400 people now working in the healthcare sector compared to December 2014. I am not satisfied additional services are being delivered. I am concerned about how we can increase the workforce on one level but at the same time not be able to deliver the service to the people who need it on the other side. I am wondering from the work the consultants have undertaken how they see the process improving in terms of delivering these additional services. The best example of all is the children's hospital which has taken us nearly 25 years. The presentation this morning referred to the provision of a new 550 bed unit, literally, every year and then to a delivery every three years. To deliver it even every three years will be a huge demand. How does one fast track something like that? From Mr. MacGinnis's experience, what needs to be done? There is the whole process of identifying a suitable site, going through the planning process, going through the appeal process, getting the work done, and then the other issue on staffing.

On the staffing of our hospitals OECD reports indicate that we have a ratio of nurses per head of population that is one of the best in the world. If that is the position, how does one deal with the increase in the number of hospital beds if one already has a high ratio of nurses per head of population; how then is the service delivered? Do we grow the number of nursing positions again or does one start looking to where the work that nurses are doing now could be done by care assistants? We need to protect the nursing jobs but we also need to make sure that they have backup support. How could that be dealt with?

The third issue concerns a totally different matter. When we introduced the fair deal scheme in Ireland, which is for nursing homes, it was a new type of delivery of service. It was introduced and put in place over a short enough timeframe and has delivered.

The problem now is that there are approximately 23,500 people in private nursing homes, plus a further 6,000 in community hospital facilities. There are approximately 637,000 elderly people in the State. By 2030, that figure will be 1 million. A proportionate increase in nursing home bed numbers would see us needing in or around 40,000 beds. To avoid it, home care provision would have to be increased. The delegates referred to a 70% increase in that regard. My concern is whether we will have an adequate number of people to provide that service. How do the delegates suggest we deal with recruiting them? On what do we need to focus if we are to get more people involved in providing what is a superb service for those who require it? Have the delegates only examined this question to the point of saying provision needs to be increased or have they actually analysed how we should increase it? We must increase it at a fast pace every year from now on, but I am concerned that we will not have enough people to provide the service. These are just some questions that immediately pop up from what the delegates have said.

As to structures in hospitals, a question arises as to whether we should change the role of nursing. The majority of nurses now have academic qualifications, but, to a large extent, we have not increased the role they play with patients. Many nurses are more than adequately qualified to deal with a lot of the issues junior doctors are handling. Should we examine workplace practices and the delegation of duties within hospitals? For instance, there is a significant reliance on junior doctors that is not seen in other countries where there are more structured systems under which permanent and nursing staff deliver services effectively.