Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Deputy Durkan for affording me the time to reply within the seven minutes. I do not disagree with the Deputy at all that the current construct of the HSE is not fit for purpose. That is not just my view but it is the view of the HSE. The former director general of the HSE said that at this committee, calling it an "amorphous blob", as reported in the national media. The HSE, as constructed, is not fit for purpose.

There is a need for a national entity, and this is echoed in Sláintecare. There are many good things in our health service that would not be achieved without a national entity, including the national maternity strategy, the national cancer strategy and potentially procurement and human resource elements. These are issues where it makes sense for them to remain in the national core, although that core is far too big and bloated. The idea is to devolve as much as possible to the regional entities, with those entities having a board and being accountable. Although it is not a criticism of people and I can find myself in the same position, all too often people in the Oireachtas raise questions because they cannot get answers at a local or regional level. Affording people the chance to access information about their own healthcare in a local or regional setting makes sense.

The Deputy is entirely correct to raise the idea of population increases as everyone speaks about the health service as though it is static. I am thankful we have a growing and ageing population. People are living much longer in Ireland and we want them to be able to live good, healthy lives, with a good quality of life. I should be clear that the mantra that there are too many beds in the Irish health service is gone, over and dead. We have far too few acute hospital beds and it is highly regrettable that we went through an era of people deciding we had too many beds. It was not an economic argument but rather an ideological argument. They believed everything could be done in primary care. Much more can be done in primary care but we have the evidence with the bed capacity review that many more acute hospital beds are required. The person who needs an intensive care unit bed will never be seen in primary care so increased acute capacity is required with the primary care element.

The Deputy is right to ask the question about primary care centres. They have the capacity to do much more. I will give the example of the one I visited and opened in Castlebar, where there is now an X-ray facility. Under the governance of the hospital in Mayo, as Senator Swanick knows well, there was a position where many people had to go to the general hospital and there was a waiting list for X-rays. The operation of the X-ray facility I mentioned has effectively eliminated the waiting list for X-rays. We have all these fine buildings and there is much good work going on in them. I do not mean to in any way downplay that. There is an ability to do much more. Deputy Donnelly and I represent a constituency with a primary care centre in Carnew and before it was in place, people from Carnew and south Wicklow were travelling to the Mater hospital for wound management. That can now be done locally. There is a definite ability to do much more in primary care, and that is what Sláintecare is about. It is also what our capital plan is about in the form of putting diagnostic infrastructure in place.