Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I welcome our guests. I pay tribute to the health workers, who have been under the cosh, for want of a better expression, for a long time. There have been three years of emergency treatment, with Covid and various outbreaks in various places, new outbreaks, and so on. It is necessary to pay due compliments to those who have soldiered on the front line in desperate situations. I also pay tribute to those who did not really have a break at Christmas-time or who had no break. They just went back into the workplace and faced greater demands, with nothing at the end of the tunnel other than more of the same.

Someone mentioned earlier that the Government should do more to exert influence at this committee. It is exactly one year since I suggested at this committee, with many people present from the HSE and Department of Health, including the Secretary General, that the structure in place during Covid should be superimposed on the health services in order to deal with the situation that was likely to happen. I was told that we would not have that until November. It is all too late. We need to plan for the kind of thing we are talking about now for next year. We also need to plan for what will happen in the interim. If we do not do that, we will never get ahead of it. If we are waiting to catch up on the demand, we need to recognise that the country's population has increased dramatically. I know we have lost beds for various reasons, including after some in the health services advised us that the secret to the future was to have fewer beds and more day beds. Now we know, but it took all that time to find out exactly what we need.

We were told that home care was the answer. We ran into trouble with that too. We need to make provisions. We cannot operate on the basis of what will happen next year unless we evaluate what happened this year and add our contingencies to it for what is likely to happen in the event of another pandemic or such. We have to factor that in. I do not think we are doing that. I do not want to criticise management or anybody else, but I am sick to my back teeth from listening to the same story again and again. One of our colleagues here mentioned that Christmas only comes once a year. It is just as well because if it came more often, we would have a serious crisis on our hands. We, the members of the committee, need to have confidence in the system now and in the future, and in its ability to deal with situations, including unforeseen circumstances, since those will always arise. This is nothing new. Management has to deal with this as a matter of urgency.

I suggest that the Secretary General of the Department of Health and the management of the HSE come together and work out a plan that works on an incremental basis as the year progresses, dealing with the situation now and what may arise in the future. They need to identify which areas are likely to come under pressure first, last, or never, and try to make sure that whatever we do from now on, we have the confidence to stand over it and say to the people outside, the patients and the staff on the front line of the health services that help is on its way now, not in five or ten years. We cannot have a situation where we go from crisis to crisis each year when it is well-known in advance that certain things are likely to happen or to reoccur. We are not doing that at present. I am not blaming anybody in particular but asking what in God's name we are doing about it that is visible and making the required contribution.

I have heard various experts on the health system in recent years at this committee, or on the health board as I have often said. We are not picking up the challenge the way we should. It is not happening and the public knows it is not happening, as do the staff at the coalface. The staff want to emigrate and go elsewhere; they do not want this unknown quantity and crisis hanging over their heads the whole time. This crisis is always around the corner waiting to happen. What we need is a plan that works. It must have stages 1, 2, 3 and 4 and if stage 1 is not working we must examine why it is not working and the same for stages 2, 3 and 4. We need to do something about that urgently.

The time for waiting is gone and from here on in we need to make a conscious decision that certain things are expected of us and that we are in the position where we can do something about it. We do not have the cheapest health service in the world. As time goes on it will get more expensive unless we deal with it. We need efficiency, effectiveness and positive outcomes for the health service. That has to happen soon.

We need to identify where the deficiencies are and fix them. Whether they are beds, staff levels or home care, we need to identify the deficiencies and deal with them because talking about them does not do anything at all and they will be there next year. If there are shortcomings in it now they will be there next year and if there are shortcomings this month they will be there next month and the following month and we will be hoping for the summer and hot weather to relieve the pressure. That is not the way to plan a health service. This is not a criticism or a lecture; it is a simple recognition that if certain things are not done then the service that is provided will become irrelevant because the people will lose confidence in it. The people are the patients and the staff are the ingredient that needs to be looked after in terms of working conditions, pay and whatever the case may be, in line with everything else. The fact of the matter is that as long as we go on the way we are going, with crisis after crisis and only chasing after it, it will not work. Whoever is alive this time next year will be back here again doing the same thing if we continue like we are.