Colm Burke (Fine Gael) | Oireachtas source

I thank the witnesses for their presentations. I apologise for being late but I had an earlier commitment. On efficiencies in the HSE and health service, the witnesses referred to medication and access to GPs. To take the simple example of the cost of drugs and pharmaceuticals, people have access to drugs and pharmaceuticals but do not necessarily use them. On generic drugs, the changes we have brought about in this area have not delivered significant savings.

We talk about pouring money into the health service without examining areas where we can create efficiencies. The witnesses spoke about free access to GPs. Since free GP care was introduced for children aged under six, which is a very welcome scheme, GPs have complained about the number of unnecessary visits they must accommodate. Likewise, if we increase free access to services, whether for pharmaceuticals or general practice, the question arises as to how we make those services efficient and ensure they are not used unnecessarily. I am not clear on whether we have examined that issue.

The other issue is efficiencies in our hospital structure. I deal with many people who work in the medical care sector and I have found there is a serious problem with morale among nursing staff, doctors, junior doctors and consultants. Many more people are retiring earlier than planned.

Such are the pressures now being put on people right across the board that they want to get out, and they are getting out three, four and five years earlier than they had planned. This creates its own problems within the healthcare sector.

On the issue of consultants, if we want to deal with waiting lists we have to have a lot more people who have the ability to deal with the lists in a timely manner, and at the same time have the backup support. Over the last three or four years the HSE has taken on more than 12,000 extra people. I am not sure whether there was an overall plan to see exactly where people were needed and what needed to be prioritised. It appears to have been a bit hit and miss and a case of whoever could shout the loudest for extra staff got the staff. I am concerned that we are talking of putting more money into the health service without looking at prioritising from one to ten and asking where it needs to start with staffing and with the inefficiencies.

I have an issue with the lack of accountability in the health service. We discussed the patient safety Bill last week and I raised this issue. When we speak about the patient safety Bill and accountability it is aimed in particular at medical practitioners and nursing staff but I am not satisfied that we have any mechanism within the current structure of the HSE for accountability of managerial staff to the extent that we need. It is not referred to within the Sláintecare report but I may be wrong on this. I am concerned.

Another issue that causes huge inefficiencies in the health service is the moving of the deck chairs within HSE management. I have raised this previously. I am aware of one hospital that had ten hospital managers in 18 years. There is a lack of continuity in that process but nobody has asked why people are moving. Is there a problem with the job or with the pay? Nobody has looked at the movement of the deck chairs within the management and administration, where people are in a job for 12 months and then they have to move on to another job 12 months later. If a nurse starts in a position he or she is more likely to be in a particular area for a period of time, and likewise with other medical staff. There is continuity. We do not have that continuity in administration. I do not see where this whole management structure has been examined with regard to rolling out the long-term plan and accountability. How would the witnesses deal with that?

Reference was made in the graph to duplication, where some people have medical cards and health insurance, and other people who have neither a medical card nor health insurance. What are the exact percentages for these groups? I may have missed that and it would be helpful for me to have those percentages.