Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I also thank the witnesses for coming before us. I hope this all works out because it is two and a half years since the report of the Select Committee on the Future of Healthcare, chaired by Deputy Shortall and upon which Deputy Durkan and I sat, was published. We are now 25% of the way into a ten-year plan. It is not Ms Magahy's fault because she had nothing to work with initially apart from our report. That committee report was born out of a frustration with the system and situation as it was. We all worked together to try and leave our bias behind and work to the future.

Following on from that, part of the issue I see now is the constant leeching of top-end consultants that this committee spoke about in the previous session and last week. Those consultants are leaving our public sector to join our private sector and we have not yet managed to stop that bleed.

As long as that continues, I fear we cannot deliver this, despite whatever else we do, unless we have the hospital consultants to lead this healthcare provision. We need to focus on the consultants. Some 50% of NCHDs are not in training posts. We have the leaching of the top people but in terms of succession planning, we do not have the bodies coming along in the future that are wedded to the system and part of a structured career path. If all of this worked out, and everybody was up for it, how are we going to guarantee that we have the consultants to lead the delivery of healthcare?

The GP contract and salaried GPs was a critical point of Sláintecare. There has been an emergence in the larger urban areas of GPs who have general medical services, GMS contracts doing many elective and cosmetic surgeries in their clinics and many travel vaccines. I do not class all GPs in this group. These procedures are not jobs that GPs should be doing in a strained health service. I would much prefer to see my child's burst eardrum being seen over somebody getting elective Botox in a surgery. I am quite concerned about the use of GPs' time. This is not a criticism as they have to pay rents, rates and salaries and there is probably more money in elective cosmetic surgeries than in weeping children's ears. I am concerned that if we do not go down the salaried GP route, we will always be competing where the skill sets of the GPs are siphoned off into sectors that are more profitable and have no public health value.

On pharmacists, we spoke about patients earlier and often speak of them as if they are all same type of patient. Any of us who works in the health service, however, knows that there are major complexities in patients. I am reminded of a pharmacist in Galway who took it upon himself to monitor ten complex patients across gender and age groups. This pharmacist together with the local public hospital and GPs, they held the hands of ten people as they went through their complex lives with their complex medical conditions. It was a loose study, but the ten individuals were admitted to hospital 30 times in the year prior to this intervention, an average of three admissions. Following this intervention, there were only four admissions in the next year. My concern is that we look on patients as if they are all the same and we never hold the hand the most vulnerable. We just keep firing money and expensive injections and treatments at them but we do not follow up whether the injection goes into their body or whether they turn up for their appointment. The group of people in Galway proved that when resources are directed at the most vulnerable and complex cases, this can have a significant impact on hospital admissions. Various figures are bandied around, but there is a claim that up to 60% of hospital admissions are due to medication errors. If, as Deputy Donnelly mentioned earlier, three quarters of beds in public hospitals are occupied by people who come in through emergency departments, investment in the more complex patients with great need seems to be the key to try to reduce the bed occupancy rate and waiting lists. How is Sláintecare progressing with the pharmacists? The fundamental basis of Sláintecare was need and not ability to pay, and a move towards the community. It must be ten years since pharmacists started doing the flu vaccine. It started off - with no offence intended towards the Chairman - with the question as to how pharmacists might manage and what if some person died or had an anaphylactic reaction? Some ten years later, is ten years correct?