Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I agree that bricks and mortar cannot be, and is not, all there is to primary care. The buildings can be enablers for change, integrated care and multidisciplinary working. I opened one in Grangegorman only a few weeks ago and, as the Senator knows, it brought together many healthcare professionals who for the first time were working together under one roof, providing integrated care for a patient. That is the benefit I see in the bricks and mortar aspect but it is not the end of the conversation. It is what happens within those buildings that is really important.

I do not want to negotiate with GPs through this committee and they never like that. Nevertheless I make the point that there are three elements to any discussion we must have. There is an element about sustainability. The Senator referred to FEMPI. I am talking about sustainability but we are both speaking about recognising the fact that GPs in many cases today feel they are in need of supports to keep their current practice and services sustainable. We need to talk about that. I hope the Senator notices I am separating this and making it a distinct point from new services. We need to talk about sustainability of our existing general practice service.

The second point we need to discuss is crucial and I referenced it in my opening statement. It is throughout both the committee's Sláintecare document and my implementation plan. This is chronic disease management. If sustainability is one leg of discussion, chronic disease management is another. What can general practice do in chronic disease management if those GPs are resourced to do it? I know from my conversations with GPs that there is a willingness and desire to do more but they must be resourced to do it. The third leg of the stool is a conversation around access to primary care and how to advance the Sláintecare ambition as it relates to access.

The three elements are sustainability, Sláintecare chronic disease management and Sláintecare access. They are the three legs of a stool about which we, as a State, need to have a very serious conversation with general practice.

The State must be able to come to that conversation with significant resources. I am now in a position to do that. We need GPs to come to the table with a willingness to engage, which I believe is there. I hope that re-engagement will shortly commence.

I agree with the Senator on smaller hospitals. We are underutilising our smaller hospital network. It is important that we provide the right care in the right place, which Senator Swanick, as a doctor, knows better than I do. Smaller hospitals have the capacity to do more, whether in terms of diagnostics, elective procedures or otherwise. I refer to the reopening of the cataract theatre in Nenagh hospital, a so-called small hospital, which will serve the people of the mid-west and reduce cataract waiting lists. I visited Kilcreene hospital in Kilkenny, which has sufficient staff to do more hip operations and sought funding to carry out such operations. I am pleased that we were able to facilitate that. Some smaller hospitals have the staff, capacity and eagerness to do more. Part of Sláintecare is to consider how best to utilises all assets and capacity within the public health service. Senator Swanick made a fine point regarding the role of smaller hospitals in that regard.