James Reilly (Dublin North, Fine Gael)

There were many issues raised. We have had the emergency department crisis running for several years. There was a ten-point plan issued several years ago at the height of the Celtic tiger and it failed to address this issue. The issue here has not been money per se alone. It must be about reforming the way we work and the system we work in, and that is what we are about.

I want to place on the record of the House my gratitude to all those working in the front line who have done sterling work to maintain a safe service, as I stated, during the grace period and also to achieve the progress they have achieved to date.

We in this House and everybody working in the health service knows there is a great deal more to do. We know there is waste and inefficiency. We know we have a system that is a whole of itself and no one part of it can function independently of the others.

We have a considerable job of work to do in terms of sorting out primary care and ensuring the right patient is seen by the right person at the right time. There is a great deal of work consultants are doing that GPs could be doing, there is a great deal of work GPs are doing that nurses could be doing, and there is much work that nurses are doing that health care assistants are doing.

One must ask the question why it is that one model for a hospital in this country has nine nurses to each health care assistant while another has three. Why can some community nursing units only manage a ratio of one nurse to one health care assistant when the London School of Nursing recommends one nurse to 2.5 health care assistants in a community nursing unit? There is a host of stuff.

I mentioned physiotherapy in one of the other questions. This is important because it shows we can change the way we work. In Cork, they succeeded in this, and it started in the UK. They screened GP referrals to consultants for orthopaedics and found that 40% of them did not need to see the surgeon at all. The physiotherapist was able to deal with them. I am sure that applies to other areas with other specialties too. Then we have a nonsensical system where if one wants to get counselling for a patient in the public system, one must refer him or her to the psychiatric clinic. A whole host of things must change.

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