Michael Harty (Clare, Independent)
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I wish to make a comment about the HSE presentation before I bring in Senators Dolan and Conway-Walsh. One of the witnesses said that the present system of care is relatively inefficient, ineffective and is ultimately unsustainable and that integration was a key factor in making the system more efficient and effective. Please concentrate on the barriers to integration and what are the roadblocks to rolling out an integrated programme.

I wish to comment on general practice but first I wish to declare that I am a GP. General practice is now akin to a slow puncture because it is gradually fading due to a lack of infrastructural support, resources and a new contract, as mentioned by Dr. Collins. We hope that the latter will come to fruition this year but the negotiations are painfully slow.

Sláintecare is a very comprehensive document. It is not perfect and not everybody likes everything in it. Key to the success of Sláintecare is a properly functioning primary care service. If one does not have a properly functioning primary care service one cannot build on integration and all of the processes that the witnesses have described.

The witnesses have mentioned that a cultural change is needed, and that we have to adapt, of which integration is a part. Concentrating on the cultural barriers, where do the witnesses feel we are not dealing with demographic changes, an increasing elderly population and an increased general population?

Integrated management has been mentioned. We have talked to representatives of the Carlow-Kilkenny team about the development of the Sláintecare programme. The Carlow-Kilkenny integrated model has been referenced significantly in the report but there are other models of integrated care. I find it very difficult to communicate with my hospital colleagues. We are trying to set up an integrated care committee in our region where we can have a dialogue with our consultant colleagues. I hope that the initiative will come to fruition. That is a key area to develop integration.

I believe every nursing home should have a designated medical officer. I mean one person who looks after the overall management of the medical structures in the hospital and implements certain protocols. Let my explain why. One may have 30 patients in a nursing home. There may be ten GPs who visit in order to deliver care to their patients but they are ten different people with ten different ideas so there is no overall structure. Consequently, when a patient falls ill overnight or at a weekend quite often the default position is to refer him or her to an accident and emergency unit. If one doctor was in charge who had an overall protocol, although not necessarily looking after all of the patients but implementing a management protocol for various acute illnesses, such an initiative could prevent many patients going to accident and emergency departments.

Finally, I wish to state that community intervention teams, that include specialist nurse practitioners, are a halfway house between a person being looked after in the community and being looked after in hospital. Please comment on community intervention teams and barriers to change, in particular.

I call Senator Dolan and he will be followed by Senator Conway-Walsh.