Michael Harty (Clare, Independent)
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We are discussing inpatient and outpatient waiting lists. There is an imbalance between the demographic changes in the population and capacity, by which I do not mean just bed capacity. We concentrate on bed capacity but there are huge capacity issues in other services, particularly in primary care.

How does CHO 3, with which Mr. Gloster is most familiar, anticipate the manpower issues in general practice arising from the retirement of GPs? How does it intend to recruit GPs and manage manpower? There are many issues relating to hospital avoidance and the GP was the gatekeeper to the health service in this regard, acting as a filter to sift through the information to decide who needed to go further for treatment or investigation. That system is breaking down now because of manpower issues and because GPs are working to capacity. How would a CHO area anticipate recruiting and retaining GPs and developing that service?

As for the reduction in the number of inpatient procedures by 8,600, which is 9.4%, what proportion is accounted for by actual treatments, and how many of those are just validations of lists? I refer to cases where people do not need the treatment any more - they have gone to Northern Ireland, have opted for private healthcare, are no longer seeking the treatment or perhaps have passed away. What proportion of that reduction reflects actual treatments as opposed to validation? Perhaps the witnesses might outline the common treatments that are being delivered through the National Treatment Purchase Fund. Are they just day cases or are they serious cases of hip replacement, knee replacement and those procedures that require a considerable length of time in hospital?

Mr. Woods and I believe Mr. Bolger referred to the 8 a.m. numbers for patients on trolleys. I have been looking at the trolley figures for the past number of years. The numbers are rising year on year. This year to date, the average number of people on trolleys per day is 500, which is not in keeping with the 8 a.m. figures the witnesses have provided. Are the 8 a.m. figures different to the trolley watch figures?

Why is University Hospital Limerick consistently the hospital with highest number of people on trolleys, with perhaps double the number of the nearest rival hospital? I have my own views on that. I think there is a much greater catchment area for the University Limerick hospitals group. There is no model 3 hospital in the group, only a model 4 hospital, so everybody tends to end up in casualty there before they are filtered. Perhaps the witnesses might comment on that.

Following Deputy Donnelly's contribution, I note that the average number of beds for countries in the Organisation for Economic Co-operation and Development, OECD, is 4,800 per million. We are at 2,800 per million. There is a huge disparity there. The bed capacity review anticipates that the population of the country will increase by a million over the next ten or 15 years. A million patients equates to 2,600 beds. The 2,600 beds that are proposed in the bed capacity review may only be keeping track of the increase in population. It many not actually be a net increase in the number of beds per person. Perhaps the witnesses might comment on that. Ever year, flu season arrives and winter initiatives come in. As a result of that, elective admissions are quite often cancelled between the months of November and March. How can the health service keep track of elective procedures if, because of bed capacity issues, a bed cannot be found to carry out an elective procedure for four months of the year?

I refer to Sláintecare. It has been 400 days since the Sláintecare report was published and we still have not got the Government response. The Government seems to concentrate on costs, but really Sláintecare is talking about reorganising and reforming the health service. It concerns integrating services and hospital reduction measures, that is, how patients can actually be treated in a better location than a hospital. It refers to treating them in a community setting and re-orientating the health service towards primary and community care. I know Ms Cowan has an interest in this. Perhaps she might comment on that.

Finally, I refer to the "Bring Them Home" measures directed at nurses. I think only three nurses have been recruited this year. There were 15 last year, 82 in 2016 and 20 in 2015. The witnesses might comment on the reasons why we cannot get our nurses to come back. I apologise for the large number of questions.