Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

This motion is perhaps one of the most important to come before this House in recent times. How we fund, govern and manage our health services over an extended period of time may be the most useful initiative that has been taken by any government in the past 30 years, and presents us with a unique opportunity to challenge forever the way we address our health needs as a society.

We have ten years to save a generation. Devising cross-party agreement on the direction of health policy in Ireland will hopefully give us long-term clarity on funding, staffing, contracts and the hospital network organisation. I hope it will also remove opportunities for political opportunism that prevent us from making good decisions about where to allocate resources. It is vital that there is recognition of the impact of socioeconomic deprivation on health. Now that we are finally entering a period of relative economic stability and growth, I believe that there is scope to address the inequality of access that exists for service users and that this committee will move to establish a universal, single-tier service where patients are treated on the basis of health need rather than on ability to pay.

We are moving towards being the most obese country in the world if we do not change course. We have an emergence of food poverty where there is an inability to afford or gain access to a healthy diet. Low income households, due to a combination of lack of money, education and access, often have diets made up of cheap, poor quality, calorie dense foods with little nutritional value. This is the root cause of the spiralling obesity epidemic. Obesity is a risk factor in four of the five biggest killers in this country and it affects all sectors of society, but disproportionately the poorest people. We have the lowest breastfeeding rates in Europe. We are witnessing a battery-fed population. A generation is coming on stream that will, for the first time, live shorter lives than their predecessors if we do not intervene. Cancer mortality is three times higher in disadvantaged areas and it is the second most common cause of death. Patients in disadvantaged areas often struggle to manage these conditions whilst facing other social and financial pressures. People who are the most likely to die have the least access to the health service. This is fundamentally wrong.

This happens when services are distributed according to number and not need. If you have the same number of services, for example, per 1000 people, regardless of where they live, those in the most disadvantaged areas get effectively half the service as they are twice as likely to get sick. In the case of primary care, there is not even the same number of doctors per head of population in disadvantaged areas. The average number of patients per GP in this country is 1:1,600. In the north west of Dublin, which has three times the cancer death rates of the most affluent area, the ratio is 1:3,600. Public patients from that region wait 11 months for vital tests diagnosing cancer, whereas in south east Dublin it is two months. I represent the south east of Dublin, and I consider two months an outrage, so what must the people and the Deputies of north west Dublin think?

As a student I worked as a hospital cleaner and ward aid in Tullamore Hospital in order to pay my way through college. Upon qualifying as a pharmacist I worked as part of a multi-disciplinary team in the NHS alongside hospital consultants, nurses, physiotherapists and others to enable a clear pathway to recovery for each patient on a case by case basis. Believe me, the NHS is by no means perfect, but we must look to it and learn from its successes and mistakes. We have an opportunity here to replicate all that is good in other countries' health services while tailoring it to the needs of our nation.

Everyone in the health system, from consultants to the cleaner, are working for the best outcomes and to deliver the service that patients require. We have gone to great lengths as a country to set up hospital networks, yet these networks are not functioning coherently, either for emergency or elective care. In a network where the primary care sector channels patients towards the major hospital in a region, that network as a whole should be responsible for the hospital-based care of its catchment population. Unless they have a clear idea of whom they have responsibility for, specialists in the major hospitals cannot plan and then deliver their service. Patients should not therefore have to cross network boundaries in order to access the care they need, other than in cases where the service they need is not available in their own network. We cannot remain in a situation where we do not know what we have, where it is, and who is in charge.

We have ended up with a situation where the quality of outcomes has been compromised because patients from all over the country are arriving at hospitals that have neither the clinical nor the financial resources to deal in a timely fashion with the volume of patients coming through their doors. In a recent conversation with a consultant surgeon, he described the dangerous deficit of theatre capacity to me in the major specialist centres, including in the Dublin children's hospitals. He told me how common it is that young, healthy patients suffer needless long-term disability as a result of delays in access to theatre. He described the service as irresponsibly inadequate. Apart from the lifelong harm that individual patients suffer as a result of all these challenges, there is the economic cost that runs in tandem with the human cost. As patients wait, occupying beds, waiting for delayed treatment, their conditions are deteriorating to a point where they then require extra operations to deal with the consequences of totally avoidable infection.

We need to accept that illness does not take the weekend or evening off. If we are to provide the best outcomes for people, we need to recruit skilled staff. A good outcome for a patient depends on the entire team being involved in his or her care in a routine, organised and regular manner. This simply does not happen in Ireland. There has been a noticeable loss of expertise in the system. This has been accompanied by poor resourcing of hospitals, worsening terms of employment for staff and improper administrative planning.

The cornerstone of any progressive health service should be the delivery of local and accessible health and social services in the community to a defined population. We cannot continue to depend on the goodwill of health care professionals in the primary care setting to advance this objective. Investment in primary care as a unique entity is required. Those of us who work in the community setting currently see it as an add-on to our roles. All evidence suggests every €10 spent in the primary care area saves the State €100 in the long run. The introduction of a functioning and universally employed information technology platform would greatly enhance efficiency and communication, decrease the current paperwork load and speed up the process from the point of access to the point of delivery and on to aftercare in the community.

Primary care remains under-utilised and under-valued. Morale is on the floor. When this new committee is formed, it will need to address the concern and confusion regarding the future of primary care. Now is the time to create a vision for that future, while the wider health care community still has the willingness and the energy for health care reform. In the past 15 years I do not think I have gone a day without speaking to multiple people involved in the provision of health care. Everyone engaged in active health care provision wants the system to be fixed. The passion among these professionals to deliver a world-class health service is driven by a fundamental desire to improve people’s lives. In the light of the recent tragic events in Cavan and Holles Street hospitals, it is imperative that the national maternity strategy be implemented as a matter of urgency. The patient is the central focus in the delivery of maternity services under the strategy, which is long overdue. If the patient is not the central focus of care, who is?

I could stand here all day listing the inadequacies of the health service. I could try to assign blame to those whom I believe contributed to getting us to this crisis. Such political opportunism would neither be constructive nor of any benefit to the thousands of citizens who require adequate care right now, as we sit here fit and healthy. I hope today we have a platform to a new dawn. We have a chance to be part of something constructive, rather than destructive. Collectively, we must face the challenges and save a generation. It is with great hope that I support the motion that the Minister, Deputy Simon Harris, and Deputy Róisín Shortall have commended to the House. I urge Deputies of all parties and none to unite in supporting it.

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