Michael Harty (Clare, Independent) | Oireachtas source

I am not going to carry out a forensic examination of the health Estimates. I will focus more on solutions to our health service problems rather than on criticism. Many of these solutions will not cost any money to implement and indeed might save money in the long term. The first issue the Minister and his Ministers of State must address is the morale in our health service. Morale in our health service is at an all-time low because waiting lists, notwithstanding the best efforts of those working in the service, are getting longer. Accident and emergency over-crowding continues and there is not enough capacity in the system. This leads to low morale in our health service. When referring to the health service, the Minister must speak about his doctors, his nurses, his therapists and his support workers. That is not to patronise, but to be inclusive and to empathise with the problems. If we can increase morale, we will certainly improve outcomes and increase efficiency. In that regard, a well-constructed ten-year plan to lay out a pathway for the health service will be very important. This plan must be implemented year-on-year once it is devised. We are not going to wait ten years for it. There should be an immediate dividend from the plan.

My second point also relates to morale. The Minister and his Ministers of State must go to our educational facilities, including our nursing and medical schools to speak to our new nurses and new graduates, including those from post-graduate programmes. We must not allow our best educated nurses and doctors to leave the country. There is a huge problem with retention of staff, but also of recruitment of staff. We need to encourage our doctors and tell them the health service will improve and that we would like them to stay to be part of that. We must give our doctors and nurses hope. In many of our nursing schools, an entire class will go to one hospital in England be it St. Thomas’s or Great Ormonde Street, Liverpool Royal Infirmary or Edinburgh Royal Infirmary. They are taken entirely out of the system and we need to encourage them and give them hope to allow them to stay in it.

The next issue is the integration of primary and secondary care. This is not going to cost any money but it will produce tremendous efficiencies and savings. We need to develop our ambulatory care centres. There is a pilot centre in Kilkenny which is working very well and I encourage the Minister to visit it. If we can investigate patients with a view to avoiding admitting them rather than to admit patients with a view to investigation, we can save huge amounts of funding and bed space. When an elderly person goes into a bed and spends two or three weeks in it, he or she becomes immobilised and loses his or her independence. It is hard to reintegrate them back into primary care and community care. We must stop having patients go into hospital as much as we can. Obviously, acute illnesses occur and we cannot prevent everyone going into hospital but if we can keep our chronically ill patients out of casualty, it would free up casualty for true casualties, which is to say accidents and emergencies. So many of our accident and emergency departments are full of patients who would not be there if they were looked after in primary care. We need to develop our primary and community care services. We must look after our elderly patients within the community, but that needs support and resources. If that support and resourcing is provided, there will be a dividend from that infrastructure by preventing patients getting into secondary care. We need to change the focus of where we spend our money. This is not going to cost any money.

When we make decisions in relation to our health service, we must fully involve those supplying the service on the frontline. So many decisions are made by HSE management without consulting the frontline staff. Frontline staff are often bewildered by decisions made by HSE officials who have not properly consulted and integrated their decisions with those supplying the frontline service. The Department of Health must take ownership of the HSE and force it to be more transparent. Many decisions are made and it is quite difficult to know why or who made them.

We have spoken in relation to primary care about extending free GP care to children between the ages of six and 12. Most medical organisations and the majority of the medical profession want to see free care at the point of contact. There is no dispute about that. There is a problem in giving free care without increasing the capacity of general practice. The introduction of free care to under sixes and over-70s has overwhelmed general practice and taken up any spare capacity if there was any. It has meant that there are now waiting lists to see one's GP in Ireland which was not the case before. It is commonplace in the UK to wait six days, ten days or two weeks to see one's GP for a routine appointment. That never happened in Ireland before. Now, however, the capacity of general practice has been exceeded by giving free care without extending the number of GPs and developing general practice to cope with the increased workload. Waiting lists are developing within general practice and we do not want to see that. If we were to give free GP care to everybody in the community, we would need to double our GP numbers but there is a problem because the GPs are not there.

We are operating under a contract which is now 44 years old and completely out of date. That contract is an impediment to the recruitment of GPs. Deputies Billy Kelleher and Alan Kelly referred to it. We cannot recruit GPs. Rural practice is the most sensitive part of general practice and we have experienced huge difficulties in recruiting GPs over the past few years. Of our GPs, 33% are over the age of 55 while 20% are over the age of 60. As they begin to retire, young GPs are not coming in to replace them because the contract is too onerous. Our GP contract is 24/7, 365 days a year. The GP has to provide the locum if he or she takes a holiday, gets ill or wants to attend an educational course. There is a huge problem in recruiting young GPs because when they come out of their training programmes they emigrate. The responsibility and administration involved in taking on a practice is too overwhelming. We have proposed that in areas where it is difficult to fill a GP post, GPs should be put in on a salaried basis. That should be an integral part of the new contract. That contract must come very quickly. It needs to come in the next year. It was promised before July this year and it has not happened. If it does not come before July 2017, general practice will be decimated.

Another serious problem with general practice is that we were decimated by the FEMPI legislation. We all had to take income cuts in relation to the emergency in our financial management, but general practice was disproportionately affected by FEMPI because not only was income taken out of the income for general practice, it was taken from the support structures that kept general practice working. General practice is now lacking huge infrastructural support. Rural GPs were also hit by their geographic locations. There was a recognition that GPs in rural areas served a widely dispersed population, but the supports that allowed that to happen were taken away as well.

The Minister has had to depart, but I will make a suggestion to the Ministers of State. In 1985 an educationist and psychologist by the name of Dr. Edward de Bono developed the six hats system for analysing problems and finding solutions. One put on a hat to teach in one way, a had of a different colour to teach in another and so on. I would love to give the Ministers of State the reference for this system which they could use in analysing and planning change in the health service.

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