Michael Harty (Clare, Independent)
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I, too, congratulate Deputy Shortall on her election as Chairman and, even more so, on bringing this topic to the floor of the Dáil and in that regard, the timely establishment of this committee so quickly after the formation of a Government. Apart from the housing and homelessness issue, the health problem is the most critical in political terms.

As stated by Deputy Kate O'Connell, the patient must always come first. In planning a health service, our focus should be on the development of systems that suit the patient rather than, as has been the case down through the years, the patient being accommodated by the system, which results in patients falling through the cracks. It is important the patient remains in our focus as we plan our strategy.

Many people are of the view that primary care is the answer to many of the problems in our health services. Our hospital system is so expensive, it is critical that primary and community care is developed. We have an ageing population and a huge burden of chronic illness. The most appropriate place for the treatment of chronic illness is the primary and community care setting. We need to integrate primary and secondary care. In this regard, the Kilkenny model, which is a pilot system involving the seamless integration of primary and secondary care, which delivers cost effective medicine as close as possible to the patient's home thereby preventing unnecessary admission to hospital, has been very successful. We also need to integrate our public and private systems. There is huge capacity in our private system that the public system, which is bursting at the seams, could tap into. The integration of public and private medicine could start the process of a one-tier system.

We should have common purpose. This is not about politics. It would make no sense to seek political advantage on health issues. We are all here for the same purpose. This issue should be above politics and the committee should aim to keep it so. The task with which we are faced is not an impossible one. Many of our other systems work well. To achieve change, we will need to challenge particular work practices and management structures. Front-line staff are often excluded from decision making. We should seek to ensure front-line staff are involved in all policy decisions because they are the people who are delivering the service.

We need to start moving in the right direction. In this regard, a strategic framework will be important. I agree that the focus of the committee from the outset should be on how to go about strategically changing the system and how to manage that change properly.