David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I will come in on my second issue, because that is what I wanted to deal with. I have four areas and probably will not get to all of them. Governance and regional health areas was my next topic. I was not part of the original Sláintecare committee, but part of the logic of the regional health areas was to end that siloing whereby primary care was over here, acute care over there, community in the middle and a bias towards investment in acute hospitals as opposed to investment in community care. We do not seem to have learned the lessons.

I will get to the regional health areas in a second, but if we look at what happened over the last couple of months in emergency departments, we have had the wrong people going to the wrong place. It is estimated about 40% of people who are in emergency departments cannot get access to out-of-hours GPs and are not being managed in the community despite the enhanced community care programme put in place. There is movement there but we are still not getting that right. It strikes me we are a long way away from the simplicity of the argument for Sláintecare, which was right care, right place, right time. That is not happening and the evidence of that is in the first instance in our emergency departments. It is also in hospitals where people are not discharged into the community.

My understanding of the regional health areas is they were to pull all of that together into a single structure, and then we would be able to start prioritising what we spend our money on and where, in order to get good value for money and better patient outcomes. I may as well finish my question because we have limited time. An argument we, as politicians, get back on healthcare is we are spending all this money, which is now €22 billion, and our guests want us to spend more money, but at what point do we ask whether we are getting value for money. In that context, do our guests agree putting in place the regional health areas and having that single structure to ensure we are making the right investments in the right place is going to be key to that, if we are to convince people Sláintecare is actually going to improve healthcare? What people look at are the waiting times and waiting lists. There are still just under 900,000 people on waiting lists in hospitals. There are 240,000 people waiting for a diagnostic scan and 230,000 more people on community waiting lists. Waiting lists are lengthening in some areas and shortening in others but they are still unacceptable. I would like our guests' thoughts on the logic of the regional health areas. There is a debate around what power they should have versus the HSE centre, but how important are the areas to the delivery of the reforms?