Michael Harty (Clare, Independent)
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I would like to get the views of the delegates on a few of my ideas on how the system can change. There is general consensus that moving more services to primary and community care settings is the way to go. As people come before the committee, we are hearing that primary care is the pillar on which the health service will change. A great deal of unnecessary work is being put into hospital medicine. I refer to chronic illness cases, for example, which do not need to be treated in a hospital setting. The other side is that a great deal of necessary work is not being done in hospitals because of a lack of access to diagnostics. There is a difficulty in integrating primary and secondary care services. There is a difficulty with communications between primary and secondary care services. All of these problems lead to increased and unnecessary costs. There is a lack of capacity in the public system. There is a lot of wastage in the public system because of the lack of integration and communication.

Many areas of the HSE work very well. Certainly, cardiology services have improved beyond all measure. Colonoscopy services in my local area have improved dramatically in recent years, although I accept that this improvement may not be universal. Breast cancer and other services have also improved dramatically in recent years, in many cases on foot of adverse incidents that led to momentum for change. However, as somebody said earlier, the general system is not fit for the 21st century. I think many costs could be saved through integration and improved communication. We are tending towards bolstering primary care services. I would like to get the delegates' views. I agree with Deputy Joe O'Reilly that using the National Treatment Purchase Fund is like putting the cart before the horse or a band-aid on a problem. If the money was being put into the public service, it would prevent people from having to access the National Treatment Purchase Fund. I would like to hear the views of the delegates on how we could transfer services to the primary care model.