Billy Kelleher (Cork North Central, Fianna Fail)
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I have. I welcome the witnesses and I thank them for their presentations.

The ESRI report indicates that over the next number of years, there will be a dramatic change in the demographics, with the consequences in terms of demands on health services, the need for us to change how we provide health care and with regard to planning. Dr. O'Shea noted we have more people living longer with chronic disease and multiple co-morbidities and while it is good that the range of treatments available is increasing and improving, it also comes at a cost.

Cost is one matter but we are quite adept at identifying problems early on. However, we are not as imaginative in coming up with solutions to meet them. Bearing in mind that it takes a long lead-in time to establish and expand the capacity of training programmes, as well as encouraging people into those various fields due to changing demographics, how advanced are we in assessing the number of professional clinicians we will need in our health services in the years ahead? Where are we in providing people at consultant level and nurse specialists in community care and geriatrics? It was stated that the health care system needs to adapt to meet the demands associated with changing demographics. How do the pathways and integrated care programmes which the witnesses are developing fit in with the recently published Sláintecare report?

Professor McDonald stated, "to fundamentally alter the epidemiology of heart failure, HF, the HSE has piloted a home-grown HF prevention service on the east coast". Is it preventive in the context of changing lifestyles and habits or identifying it and then addressing it in a clinical setting? What type of resources will be required to roll this out across the country?

It was stated that, as a result of the virtual clinic intervention, for every 100 cases discussed, there is a reduction in emergency room-acute medical unit referral by 90% and outpatient referral by 80%. In our deliberations at the Sláintecare committee, it was evident there is significant silo thinking in our health services between hospitals, community care and GP services. GPs told the committee that in some areas, depending on the consultant, the chances of ever being able to talk to that consultant are diminished. Rather than having the goodwill of individual consultants and GPs having a personal relationship, surely we need to have to a defined system in place where there can be continual contact between GPs, who are specialists in the community, and consultants in the hospitals. Is it possible to break down those barriers?

Speaking to nurse practitioners and emergency medicine consultants at the coalface, there seems to be a cohort of elderly people who are transferred from nursing homes to hospitals. If there were a greater number of geriatric community services available, such as specialist nurses able to insert intravenous antibiotics in a nursing home, these older people would not necessarily have to go to hospital. Another issue, which causes great distress to the individual and the family, is the lack of palliative care available to people in nursing home settings. Are we transferring elderly people unnecessarily from a nursing home, which is effectively their home, to a busy hospital setting? Should there be proper community services available in clinical and palliative care.

Professor Collins stated:

The success of acute treatment of stroke is extremely time dependent. Over 60% of our stroke patients currently do not present to our emergency departments within an ideal timeframe.

He referred to the success of the Act FAST television campaign in identifying when someone is having a stroke and getting them to a hospital in a reasonable time. He also stated, "a third to half of all strokes may be prevented through lifestyle change, management of blood pressure and identification of an irregular heart rhythm, and a nationwide approach to cardiovascular disease prevention". There are two types of prevention. The first is a rapid diagnosis whereby the person gets to hospital quickly which prevents a severe outcome. There is also prevention where one identifies early on people who are potentially at risk of a stroke. Will Professor Collins elaborate on this?

Across all the health services, we need to move to a situation where hospitals work beyond the traditional five-day week, eight-to-late model, particularly in the area of diagnostics. Have the witnesses identified ways whereby we could use our assets and infrastructure in a more efficient manner, bearing in mind that an MRI in a private hospital can be done every hour but not in our public systems. We do not have that enhanced capacity in our public system because of demarcation lines and industrial relations issues. Would it make a big difference to the capacity of the health services if we are able to address rostering issues, increase the number of professionals working in the health system and use the assets that are already there effectively in diagnostics and prevention?