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

I welcome our guests and thank them for their frankness.

We might agree with some of it but we have to ask questions as well. Pay parity is not something we can renegotiate in public. It is a matter between the relevant bodies, the HSE and the Minister. It would be inappropriate to suggest what should be done. With whom are we competing for places in the international sphere to attract people? Are we competing with the UK, France, Germany or the Netherlands, or are we competing with the Middle East? The idea that we can compete with the Middle East is a myth. It is not possible and we need to be careful about going down that road.

We need also to address the capacity deficiencies. This committee has discussed them many times over the past year or two. There is an urgent necessity to address them and that is being done in the context of Sláintecare. I am not so certain it will be possible to accelerate the programme. Dr. O'Hanlon referred to the under-costing by the committee on Sláintecare. I do not want to be a dampener on this subject but we have to bear in mind that the country still has a €210 billion debt following the recovery. The theory is that we recovered from the financial and economic crash; we have. We have almost got to current budgetary levels such that we can pay our way on an annual basis but we would not want to fall asleep on it. Rather than create the impression that there is endless money available, we need to recognise what we are competing with in all the other Departments.

We are among the top three or four OECD countries in health expenditure. I would like all of our witnesses to comment on why we are so close to the top in terms of expenditure yet so close to the bottom in terms of delivery. We are not doing well in that pecking order. It is having a debilitating effect on health services in general at every level. If it becomes known nationally and internationally that we have a serious deficiency, we cannot deliver, and we are way down the ladder in delivering to patients, then nobody will want to work in that service. I agree on the filling of general practitioner posts but those posts have been done down over the past few years, although not necessarily by anything the general practitioners have done or failed to do. It has become the norm to say that they are underfunded and do not have the capacity to deal with the volume of patients in their areas. The volume of patients is increasing and the ageing population is against us. Incidentally, that is not all true. We have more young people in this country now than we have ever had. It has now been recognised, reluctantly, within the service that particularly in the greater Dublin area and the east, there is a huge number of young people in the system relative to older people. It is different in other parts of the country but we need to recognise this.

Which of the countries with which we are competing for staff and facilities has a system that is working the way we want ours to work? It is as simple as that. I am not a great believer in the HSE as a structure for delivering services at all. It is not possible to have a dual system such as we have with the Department of Health, on the one hand, dealing directly with people and the HSE, on the other.

We were all informed that the purpose of primary care centres was to intercept the patient at an early stage and deal with those issues that could be dealt with at that level. I am not sure I have evidence yet that it is happening. I would like to see the evidence and hear more about it. We have systems within systems and we all seem to be competing with each other. The result is that the patient appears to wait longest. When a patient is told they must wait for a year, a year and a half or two years, he or she is dismayed. The patient's confidence in the system to deliver is gone straight away. There is no use waiting around for it. It just does not work. There is something wrong with the way we deliver the services and while there is a money element to it, there is also something else. Our systems are not interlinking and the various systems are not complementary to each other. They are working independently. Consultants will tell us that if they were looking for access to theatre, theatre staff or back-up services, they may not be available at the time they want them. As a result, the patient has to wait. It is not good enough.

We need to monitor pay parity. We need to compare our delivery of services with those who have better deliver of services while spending less money. Our own credibility, and my credibility as a public representative, are on the record when it comes to telling the public what they are supposed to do in those circumstances.