Michael Harty (Clare, Independent) | Oireachtas source

As this is the first time I have addressed the Chamber, I would like to thank the people of Clare for the honour of being elected to the Thirty-second Dáil.

The Irish health system is struggling to cope with demands on its services. The fundamental issues currently are a lack of bed capacity within our hospitals, a recruitment shortage of specialist nurses and therapists, a lack of morale within the health service and a lack of long-term vision for the future of our health services. The current model of health care in Ireland is not working in many areas. A new model of care needs to be developed to cope with our changing health needs which include an increase in our overall population, an increasingly ageing population and the funding of new treatments and innovations of care coming on stream year on year.

These are challenges which need to be planned for in advance, rather than being reacted to when problems arise. We must develop a ten- to 15-year ring-fenced framework for health planning that will transform our health service into an efficient and effective model of care which will respond to patient needs. Many areas of the health service are functioning very well, including medical and surgical assessment units, which are trying to take the pressure off our overcrowded emergency departments. However, these units need to be expanded in size and opened as seven-day services. The Minister referred to community intervention teams and these are making inroads in allowing patients to be discharged early from hospitals and keeping them within the community. Other services, such as cancer care and cardiology, are now of an international standard. We are delivering high quality care across specialties when given the space and resources to do so. However, our specialist services need to be protected from hospital overcrowding, so that elective procedures are not continually cancelled, thus extending waiting lists that are already long. There is a disconnect between primary care in the community and secondary care in hospital. There needs to be a new integration of care and communication between primary care and general practitioners on the one hand and specialist secondary care in hospitals on the other. This should form a new model of care where, in so far as possible, patients are looked after in their community rather than in hospital settings.

We must have active management of outpatient lists and increased shared care between chronic disease clinics and our GPs. We must embrace technology. Virtual consultations would prevent unnecessary hospital attendances, while still providing an excellent quality of care. The development of primary care teams is far more important than the development of primary care centres. Building primary care centres and centralising services in one building will not necessarily improve patient access to services or deliver better patient outcomes. However, ensuring primary care teams are properly staffed and resourced will deliver a better quality of care. The provision to general practice of diagnostic equipment and staff would also allow appropriate decisions to be made for patients in the correct and least expensive setting. Rural practices need to be supported, not undermined, as do those practices in deprived areas. Obviously many illnesses require hospital treatment and this is unavoidable. However, if we are to free up scarce hospital resources, we must endeavour to look after our ageing population and its increasing burden of age-related chronic illness, such as diabetes, heart failure, chronic lung disease, arthritis and mental health issues. These need to be managed within the community, thus preventing acute worsening of these conditions and preventing prolonged and recurrent hospital admissions.

Some 99% of patient time is spent living in the community, being looked after by GPs and community-based services, yet the hospital services consume over 90% of our health spending. This spending ratio needs to be refocused to reflect where chronic and preventative care should be provided. The Irish health services require more generalists, GPs and those who specialise in medicine for older people, who can look after chronic disease. Day care services, such as assessment units or ambulatory care units, which review patients in a timely manner, should be part of the new model of care. In these units, patients should be investigated with a view to discharging them on the same day, unlike our current model which is to admit them to hospital with a view to investigating.

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