Colm Burke (Fine Gael)
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I thank the witnesses for their comprehensive presentation and for the work they do. The witnesses have clearly set out the need for change and for further education on a lot of issues and they also referred to trying to get change in the HSE service. A big complaint I hear from practitioners is that when they can clearly see the need to approach a problem in a different way and they try to effect change, there is resistance to getting the change. Practitioners complain to me that when they come up with a comprehensive plan for a change, they encounter resistance. I am referring to both people who work in the community health care sector and those who work in hospital services. The witnesses have given us the figures for the demographics but have targets been set for trying to achieve the change required in each area? Within the HSE's different regional health divisions, is change happening more in some areas than in others and are clear targets set in each area?

I also wish to raise an issue regarding people who working in the community - and I have raised this previously in the health committee - and the numbers of nurses working within the community. Over the past three years the numbers of public health nurses have gone up from 1,460 to 1,540. This is an increase of 80 nurses in real terms. Do the witnesses believe there should be an increase in this area and is there a need for targets to be set around people working out in the community and working with people, rather than patients having to come in to the hospital service? Over the same three-year period there has been a huge increase of 17% in the number of people in administration and management. I raise this issue in the context of priorities within the HSE. On the one hand there is resistance to change and on the other, we do not appear to be recruiting staff in the areas where we really need people - and especially in the types of services the witnesses want to provide.

A GP told me recently that there are only about two consultants in the area in which he works - it is not the Cork area - that he can actually telephone to discuss patient care. He spoke of the disconnect between those who work in the hospital system and those working in the community, especially GPs. The witnesses have given the example of the innovative communication project between GPs and consultants. How could that level of urgently-required communication be fast-tracked in order that more people can be kept out of the hospital services and in order that those who are working in the community can deliver the service that is required? The practitioners in the community also need this support. I believe this is one of the things we need to do but how do we fast-track it to make sure the back-up support is there for those working in the community?

I thank the witnesses again for the work they are doing and for the innovative projects they have taken on in this area.