Seán Sherlock (Cork East, Labour) | Oireachtas source

We welcome the motion to develop a single long-term vision or plan for the provision of health care. I add my congratulations to those of others to the two Ministers and acknowledge Deputy Róisín Shortall's singular vision in creating the motion. We are in positive mode in relation to the potential of the committee and will engage productively with it. I welcome the tone of the Minister's speech in that there appears to be a genuine willingness to engage with all parties and all Members in this Dáil in seeking a meeting of minds on how we can figure out and instigate a proper vision for the provision of health care into the future. If we are honest, we can reasonably assume that there is much common ground between us on the needs of citizens. There has to be a particular focus on the continuum of care as between primary, secondary and tertiary care.

The one question I have on the creation of the committee is how it will dovetail with the commitments in the programme for Government. Will it be a tool of Government policy into the future or what mandate will it have if it comes up with a set of recommendations that do not tally with the commitments in the programme for Government, of which there are many? Given that approximately €13 billion is to be spent this year alone in the health sector and considering the many commitments made in the programme for Government from primary care through to secondary and tertiary care, including mental health, the issue of resources will have to be addressed within the remit of the committee. If we are to aspire to having a comprehensive continuum of care between primary, secondary and tertiary care, including community care and mental health service provision, it will cost a good deal of money and clear choices will have to be made. To be fair to him, the Minister mentioned this in his contribution when he referred to the trade-offs between efficiency and equity and comprehensiveness and cost control. This is something that will merit further interrogation.

I welcome the document Better Health because it provides a good template and sets out the parameters within which we are operating. Some of the challenges in health care provision include the fact that the number of people aged over 85 years in Ireland is, according to CSO estimates, increasing by approximately 3.3% each year. This presents a major challenge for all of us in the management of demographics. Some 38% of Irish people over the age of 50 years suffer from one chronic disease. Chronic diseases account for 80% of all GP visits, 40% of hospital admissions and 75% of hospital bed days.

The Minister speaks strongly about focusing on primary care and trying to intervene as much as possible at that level. That is something on which we all agree. The aim of such a policy should seek to ensure people are kept out of tertiary care facilities for as long as possible and that interventions are made at community level. That would have a major impact in patient care and would also create the ability to reduce costs and be more efficient in the use of resources. On the flipside, it would require a massive injection of capital into the primary care system. If we are to manage the demographic challenges and the ongoing challenges in chronic care services, as I have outlined, in that paradigm primary care facilities will need resources.

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Speaking as a former Minister of State with responsibility for research and innovation, the last Government created a health innovation hub. We created a demonstrator model whereby we sought to utilise the best research that exists from a geographical perspective in terms of medical devices and services. We sought to inculcate the thinking that exists based on the research that is ongoing within our academic institutions as a means of seeking to ensure those greater efficiencies. I am not sure where the health innovation hub stands at present now that there is a new Government formed. However, I believe that innovation and engagement with stakeholders in the academic space is going to be vital. We will need a proper analysis of population figures and a sense of inculcating some of the thinking that exists within academic institutions to determine how we are going to provide the vision that is necessary.

I believe that the primary care centres are one mechanism by which we could link up with academic institutions to try to drive innovation and to ensure, as Deputy Kelleher stated earlier, that more diagnostics take place within the primary care settings so as to prevent people from presenting to secondary and tertiary care facilities and to keep them at home for longer. The data that is used can then be analysed and partnered with medical device companies, innovators in the health care provision space or academics to try to analyse the data so that we can then produce policy outcomes that deliver the efficiencies that are necessary for the system. We need more of that within the system. It is a case of mainstreaming that into the system because currently it is peripheral.

We need to have a greater interrogation of the relationship between the HSE and the Department of Health. There is still some siloed thinking in how the HSE, this House, the Department of Health and the Minister interact. We need a greater interrogation of that relationship to ensure that there is more transparency around it. We also need to look at why there is a constant need for a Supplementary Estimate on an ongoing basis. I say that objectively. Taking this year for example, if there is provision made at the start of the year for €13 billion, will this committee have a remit to examine and interrogate the deployment of resources more closely? We need to look at it in terms of seeking efficiencies for the system in order that the citizen can have confidence that he or she will have access to the services that are necessary, whether he or she presents to a GP, a secondary care facility or a tertiary care facility.

We need to look at the whole issue of health insurance and we need to talk to the health insurance providers. We need to look at why there is spare capacity within secondary care facilities, such as Mallow or Ennis, where more elective surgery could be done. We could take much of the constraints that are in hospitals such as Cork University Hospital and radiate more services out to secondary care facilities. With regard to mental health, we need to have a proper discussion on how A Vision for Change is implemented and resourced.

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