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

Long threatened comes at last. A number of points are being raised that we have raised here before. One thing I worry about is the morale of those within the health services, who always happen to be the fish within the goldfish bowl from a critical point of view. As the last speaker said, a lot of important work has been done and dedicated staff do a great job. However, there is some flaw in the system somewhere. I refer to the point raised by Senator Swanick a few moments ago about someone who gets an appointment for two, three or four years later. That is farcical and is an insult to the system. It is an insult to human intelligence and to the patient. Effectively what it says is the patient does not need any treatment at all and should come back in ten years. That is what should be done. The problem is that the person in question remains on a waiting list for a long time. As a result, when their condition deteriorates they come to the accident and emergency unit because they have to go somewhere. Such patients are concerned about their health and their families are concerned about them. To what degree can the witnesses identify and influence the deficiencies within the system that impede smooth progress from the moment that the patient comes into the GP to the referral? Has the HSE had an audit carried out to reveal them? It should not take six months from the GP's referral to get the consultant to meet the patient, and another three, four, five or six months before any action is taken. That is just about the most outrageous system I have ever heard of anywhere. If those results were seen in a factory somewhere or in any other organisation in society, it would not be tolerated at all. Yet in the most sensitive area, that of health, this is commonplace.

There is another issue on which I would like a response. I do not propose to wait here for the answers. I expect to get the answers at some stage between now and next week. Otherwise I will put down parliamentary questions. In case someone says I will not get the answers in parliamentary questions, the answer to that is I will.

The age profile of the population has been referred to as one of the main stumbling blocks as to why we cannot provide a proper health service. I agree with my colleague, Deputy Donnelly, that that is not correct. We have a younger cohort of population than almost any other country in Europe. The people who come into this country are young, in their 20s or their 30s. That is being balanced all the time. It is not sufficient to say we have many old people who have three or four procedures a year and so on. I do not buy into it.

Have the deficiencies in the system been identified? Is there a lack of GPs? Is there a lack of consultants? We have identified a lack of beds. Another 1,000 beds or so would make up the difference. I remember during the boom times ten years ago that there were unacceptable waiting lists, even though there was plenty of money available. I do not understand why we are not progressing. We are in the top three or four in terms of expenditure in the OECD countries, but we are in the third or fourth worst in dealing with patients, waiting lists, downtime and so on. Why should that be? The point made by Deputy Donnelly is accurate, that there is something wrong somewhere.

Can the witnesses tell the committee how many of the facilities are vacant or idle at any given time in any week, and for how long, for example, clean air theatres and different types of theatres? When a patient comes into the system, is there a guarantee that patient will move through the system smoothly and out of the system again? Is it a lack of anaesthetists, nurses or beds or a combination of all? To what extent does each of these issues constitute a proportion of the totality of what is required? We need to know that. Any efficient body will need to know exactly where its weaknesses are and what can be done to speed it up.

Some hospitals have better records than others in terms of waiting times, bed accommodation and so on. Why is it that they are successful while others are not? There are obviously contributory factors. I do not expect to be told today but I expect to get the answer to that too.

I know there are many good people in the health service. I would like to have a health service that everyone would want to identify with, that every patient would be happy to be part and parcel of, and that as a result of that we would move forward, taking our responsibilities seriously and recognising them. Incidentally, I do not have a hang-up about the private or public sectors, but they should be able to compete with each other. It is always a good sign for both of them but it does not always happen. If it is found that the private sector is creaming off the top a certain number of patients who are easy to handle or whatever the case may be - I do not know - but I would like to know about it. We trotted this out before about primary care centres. I do not know. The jury is still out on the primary care centres. They are fine facilities and they look good. I am not so sure of the extent to which they are cutting off the flow of patients at the community level before they go to the hospital. I am quite sure they could.

Today's long-term patient on a long waiting list will be an emergency at some stage. We either deal with it in the first instance or we deal with in the last. I do not expect to get the answers today. I have parliamentary questions about all of them, and they might be answered in that way.

I appreciate the Chair's patience in waiting for me.