Eamon Ryan (Dublin Bay South, Green Party) | Oireachtas source

-----so I thank the Acting Chairman for her intervention in that regard.

The Minister set out a range of ways in which we are increasing investment in the employment of additional nurses and the provision of additional beds, but it is not having a proportionate effect in a reduction in either the number of patients going to hospital or the numbers ending up on trolleys in our acute hospital services. The question is how we can be more efficient in everything we do. We would argue that we should start with the paramedic service. We should give the paramedics a significantly increased role in how we manage the process. It is not a matter of them arriving in the hospital, queueing up and that is their business done. From what I have been told with respect to a military medical approach, we believe they could be part of a triage system where they and the local community health centres would be given a key role in trying to reduce the number of people going into the emergency departments in hospitals by being able to make decisions in the front-line, first responders process whereby a person presenting with a certain condition does not need to go to an acute emergency centre but can be treated at a local community health centre or by a local GP. That would provide some flexibility and some triage management of how we get people into hospital in the first place.

Everything in our health policy is directed towards a community health system. Every party is advocating this but the question is how do we do it. We believe that advanced practitioner nurses could provide a significant role in addition to the community health centres or community health organisations, which the Minister referenced, or community health organisations in carrying out many procedures in the community. From what I have heard from the small number of advanced health practitioner nurses on the ground, they are having a significant effect in reducing the expenditure incurred in the hospital system because they are working well in providing procedures at home. It is not easy to get such practitioners. They require high-level training. In rural areas in particular they have an even more important role. Their role needs to be combined with that of a local GP service to manage the delivery of rural health services in an efficient and effective way. We need to invest in that process as our first response to the crisis we face.

At the centre of our health policy is removing the division that exists between the primary care and the hospital-based system. While I acknowledge that the doctors among the elected Members would be better able to speak on this point, from I have been told by colleagues, it appears that GPs do not have sufficient contact right through the hospital process. It would be a better and far more effective system if it were managed through information technology or through a community-centred approach first in order that the community hospital organisations manage the hospital process rather than vice versa, and that the GP has a critical role as a patient goes through the hospital system in providing advice and being able to refer case history information about the patient. That is a role for the GP. We see the GP as the central organiser right through the system rather than this extenuated differentiation between primary and tertiary care.

We would argue also that there are a range of advances we can make in the use of digital information technology and e-health services. While there are people in the Minister's Department seeking to develop that type of technological approach to being more efficient in everything we do, it is not getting the due attention and emphasis it deserves. It is one of the ways in which, first, we can keep people out of hospital by using all these new remote sensory monitoring systems and so on and, second, manage this complex operation. It can allocate resources and patients to the right places. We do not believe we have availed of the full opportunities that exist in the advancement of e-health technology to deliver the efficiencies we need. We have an overriding fear of experimentation, going back to the PPARS example, where there is the perception that whatever a public servant does, he or she should not get caught out investing in some technological system that might not work and that it could end his or her career. We need to stop that and allow for experimentation, failure and local units to devise their own open code software systems for health care management. To use a military metaphor, the US veterans health system is one of the best public health systems in the world. One would not associate that with the American military but it is. It treats its veterans in a highly efficient, very low cost, best quality system. I understand one of the ways it does that is through the use of a range of advanced, open source, collaborative technological applications. That may seem a million miles away from the real crisis here with people lying on trolleys in hospitals today, but in terms of public policy, our job is to use our money wisely for the benefit of patients, and that requires us to be willing not to over-regulate and allow for experimentation, to stop it being a box-ticking exercise and give the health professionals the freedom to experiment and concentrate on the patient. That is what that technology allows us to do.

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