Michael Harty (Clare, Independent) | Oireachtas source

As I was saying before the debate adjourned, general practice is under severe pressure as a result of the cuts introduced under the Financial Emergency Measures in the Public Interest, FEMPI, Act, as well as the undermining of general practice and the failure to support it properly. If general practice is to be part of the solution to problems in the health service, and I believe it will be central to that solution, it needs to be supported. Many areas have lost their general practitioner and many general practitioners who will retire in the near future may not be replaced. Some 33% of general practitioners are aged over 55 years and 20% are aged over 60 years. New graduates are not taking up general practice because the current GP contract is not fit for purpose. A new contract must be urgently negotiated as part of any new framework for future health care and the cuts made under the FEMPI legislation must be reversed.

Patients spend 99% of their lives living in their communities where they are cared for by their general practitioner, public health nurse, community intervention teams and community therapists such as physiotherapists and occupational therapists, and supported by community pharmacy colleagues who supply essential services. If these services were to be fully developed, many patients could be looked after in the community and unnecessary hospital admissions avoided, thus taking pressure off overstretched accident and emergency departments. This could be achieved by managing chronic illnesses and old age in the community.

Ireland's demographic trends are frightening, with 20,000 people reaching the age of 65 years each year. Furthermore, patients aged over 85 years account for 14% of bed occupancy in hospitals but only 1.4% of the population. It is clear, therefore, that demographics are causing severe problems in hospital capacity.

It is essential that bed capacity in hospitals is increased. Hospital bed numbers are currently approximately 500 lower than what is required. Hospitals work most efficiently when operating at 85% capacity and yet many of our hospitals are operating at 100% capacity, which causes inefficiency.

We must also develop home care services and packages. Despite being highly cost effective, these services are the first item cut when the Health Service Executive seeks savings. This approach creates a false economy. Cutting home care hours and packages has a negative impact because people end up as patients on trolleys or occupying expensive hospital beds.

Services must be integrated.

We need ambulatory care and medical assessment units. We should be investigating patients to ensure they will not be admitted to hospitals, rather than admitting patients to hospital to be investigated. Many acute illnesses cannot be avoided and these are the ones that should be dealt with effectively and efficiently in our cluttered accident and emergency units.

In order to build a proper health service we need to reverse the measures introduced by the FEMPI legislation and to support general practices in rural, urban and deprived areas. A new flexible contract for general practice is essential. If we are to introduce free GP care for everybody, we will need to double the number of GPs we have in our service. If the service is to be efficient, we need to see an integration of primary and secondary care. Increased access to diagnostics is essential. Many of our diagnostic services operate between 9 a.m. and 5 p.m from Monday to Friday and close over the weekend. This is inefficient. Patients are staying in hospital over weekends waiting for scans which should be provided during that weekend period, thus allowing them to be discharged.

We need to properly fund chronic disease management - diabetes, heart failure and chronic respiratory illness - and increased community supports must be put in place to help elderly patients with multiple morbidity issues. Primary care needs to be the engine that drives major health care reform and I hope that will be part of the new committee's remit. The bed capacity issue is exacerbating the accident and emergency unit crisis, but the emphasis in the proposed health reform must be to keep people out of hospital, thus freeing up accident and emergency units for essential cases.

I commend the motion to the House. Reform should be solution driven and should produce recommendations that centre on patients, are transparent and provide accountability. Input from those who provide front line services is essential.

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