Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I agree with the Chair about pharmacies. The Department is working closely with the HSE and the Irish Pharmacy Union, IPU, to enhance pharmacy care. We are considering a number of approaches. One is the introduction of a minor ailments scheme, which is something that the IPU has rightly sought for a long time. Another is a medicines shortage protocol to allow pharmacists to substitute medicines more readily. A third has to do with contraception. There are others, but we need to get going. Pharmacists are trained and capable of providing more advanced care than they are currently allowed to provide. We are working on that.

I agree about GP access. We have shortages. There is a mismatch between capacity and demand in general practice. There are many reasons for that. Ultimately, we need more GPs and practice nurses, particularly in some parts of the country. We are tripling the number of training places. This will make a big difference in time, but not this year or next year. What we can do this year and next year is fund the hiring of many more practice nurses, investment in IT systems and additional supports for GPs and attract international GPs to Ireland. We are working on these matters.

The Chair's story from the emergency department was heartbreaking. That should never happen. No healthcare professional anywhere would stand over it as an appropriate level of care. It should never be experienced by patients and their families. It should not be experienced by our healthcare professionals either. It is deeply traumatic for everyone involved. There are actions under way. We have discussed many of the preventative measures we are putting in place to keep people out of hospital. I do not know the specifics of the elderly lady, but it might be the case that there was some advanced community-based care like our older persons teams that meant she might not have needed to go to hospital. We are putting a great deal more capacity into hospitals. There are emergency departments that are putting in place older persons pathways, whereby older persons are seen in separate areas and there is a focus on geriatricians, those skill sets and discharge options. None of us would ever stand over what happened. That is the world that we have to move on from. While I am reliably informed that a positive face might sometimes be put on things when I arrive into an emergency department, I have also visited emergency departments at midnight. On planned visits, I have seen situations as well. In my experience, the healthcare professionals working in emergency departments want me to see what their patients and they themselves have to deal with. In most cases, they do not hold back. Nor should they.

We are dealing with an historic underinvestment as well as a rapidly growing and ageing population. The demands on our care and health services are increasing rapidly. The goal that everyone in the Oireachtas agrees on is universal healthcare. We are making great progress on patients' costs and the services available to them. For the first time in a long while, we are making progress on waiting lists. There is a focus across my Department and the HSE on emergency departments. We are moving away from the idea that we will have a winter plan every year to the idea that we need a strategy for urgent care, with ambulance services, GP out-of-hours services, minor injury units, medical assessment units, emergency departments, discharge options and community care teams working together. Within that strategy, we ramp up resources in the winter for obvious reasons, but it moves us away from the idea that, since our services do not have the capacity they need during the winter, they get a bit more and try to struggle on. We need to approach this issue much more strategically in terms of prevention, community-based care, hospital care when necessary and discharge options. That is what we are trying to do. We cannot and will not be able to solve it all in a matter of months – it is taking time – but at least there is ongoing investment in capacity at a level that has not been seen in a long time.