Alan Kelly (Tipperary, Labour) | Oireachtas source

I thank the witnesses for their statements. Today has helped to bring together the various components that must be put in place. It is a jigsaw that must be put together by January and then monitored continuously. We can all see that is going to be quite difficult but it must be done.

The presentations were very well put together on what needs to happen in the pre-nine weeks, nine to 12 weeks and post-12 weeks cases. While we can see the care pathways, there are issues in respect of interaction between GP services and primary care services and even geographical coverage, in south Kerry or north Donegal, for example. Issues will arise there. How can we ensure that provisional pathways are put in place to ensure that all those points are covered? What analysis is being done between the groups represented here working with the Department? I will return to those two meetings or non-meetings. What analysis is being done on this? No one can tell me that we have universal coverage or that there will be a universal coverage map based on the pathways as outlined. When I look around the country, I know that they do not exist and this will be even more the case in this regard. What work is being done? If no work has been done on it yet, the witnesses should be upfront and say so, because then we have a serious issue because we will have to solve it in the next 12 weeks. There is an interconnection between GPs, primary care setting and hospital settings and there are gaps there. How will we address that?

My second question is connected to that and relates to the meetings with the Department. I do not think that a lot happened at those meetings by the sounds of things. I do not want to put Dr. Murphy on the spot but the Department of Health needs to drive this but, with the best will in the world, it does not come across to me that it is doing so.

I do not want to overlap with the issues that have been outlined by previous speakers. Where are those issues in the discussions that have taken place? Where is the issue I have just raised? Is a plan being put in place? Have the witnesses seen evidence that a plan is being put in place? Maybe they can elaborate on what was discussed at the two meetings. How much progress has been made on foot of those meetings?

In moving on to my third question, I will not ask about the three-week rule and the infrastructure in hospitals. I respect what everyone has said about the Medical Council guidelines. In some scenarios, GPs deliberately act in a manner that does not involve referring people on, or camouflages the way in which that happens. We all know about the issues with clinicians that have arisen recently and have been considered by Dr. Scally. We will talk about them in the Dáil later. How are we going to make sure such issues do not happen? Where they do happen, how can we ensure they can be dealt with quickly? The issue of geographical coverage arises again in this context. When doctors behave in a certain manner, how can we deal with that clinically and quickly? That is my third question.

The fourth question I would like to raise is a quick one. I presume the witnesses support the concept of a 24-hour helpline. Various underlying supports, including infrastructure, are needed to kick that off while we do not know what coverage we have.

My fifth question relates to the role of public provision versus private provision. Concerns jump out to me regarding the latter. What are the thoughts of the witnesses on private provision? I have not fully worked out my thoughts on it. It seems that where there is private provision, there are concerns in respect of aftercare. There are also concerns about knowledge that is not being garnered or put into the public setting, and the gaps of information because of that. I suppose it is possible that some individuals will be targeted if they are just in a private setting. I have asked five questions, some of which overlap. I do not mind who answers them as long as they are answered.