Michael Harty (Clare, Independent) | Oireachtas source

I thank the Ceann Comhairle for the opportunity to contribute to this debate on the interim report on the Committee on the Future of Healthcare. Deputy Shortall referred to the work of the committee and I also want to compliment the members of the committee. We have had a very positive debate at each weekly session on how we should go about changing our health service. I am a great believer that being in the right place at the right time is far more important than all the policy background decisions that one can make. We are in the right place at the right time. There is now an understanding of how we should move towards a universal, single tier health service where people get care based not on their ability to pay but on their need. Putting the patient first should be kept on our minds whenever we are speaking about this because it is a health service for the patient and we should wrap the service around the patient, rather than the patient trying to accommodate to the health service. That is the way the service is currently going; it is an ad hoc service which tends to be self perpetuating. Many parts of our health service are working very well. We all tend to be critical of our health service when we see the accident and emergency trolley count and the waiting lists. The problem is getting in to the service. Once a person gets into it, the service works very well. It should be acknowledged that many parts of our health service work very well.

Rather than looking horizontally, we need to look vertically down on our health service in a bird's eye view to see what is happening, why is a patient in one place when they should be elsewhere or why is a particular system not working. Looking at it vertically rather than horizontally we should be able to see where the problems, the roadblocks and the challenges are. We have a great opportunity to drive change.

With regard to the political input into health care, as the Minister said at the committee this morning, there needs to be a political input into the policy of health care, but once the policy is devised - we hope we will have a ten year policy - then it should be taken out of the hurly burly of political change such as the change of Government or the change of Minister. The plan should be there and it should be implemented irrespective of who is in government.

Time after time, the theme that comes though from each witness to the committee is the need to transfer from secondary care to primary and community care, particularly for chronic disease management. Secondary care should be a specialised service for complex and acute medicine. It should not be there to look after the day-to-day illnesses that people develop which should be looked after in primary care. We can keep people out of hospital if primary care is properly resourced. Once people go in to hospital the meter starts ticking. It is a hugely expensive way of looking after people. Coupled with resourcing of primary care we need also to integrate primary care with secondary care. Resourcing primary care on its own is no good as there has to be integration between it and secondary care. There needs to be a streaming of patients into secondary care in a constructive manner.

It is unfortunate that our accident and emergency departments are a catch-all for everything. Trauma, addiction, alcohol overdose and all the social problems that occur in our society end up in the accident and emergency department. Patients should be streamed away from the accident and emergency departments and into medical or surgical assessment units or to addiction or psychiatric services and the accident and emergency service could be kept for what it is meant to be. We need to integrate our services. Last week the committee spoke about integrated local care committees where GPs, consultants, management, nurses and all the various elements that go into supplying our services sit down as equals around a table and thrash out the problems. There should be no inequality in how we plan our service. That would be true integration of our services. I am a little worried about the community health organisations. They are coming from the top down and they have not been explained properly. We are worried that they may not be the answer to the integration of services: it should come from the bottom up with local integrated care committees. The role of community health service is that we want keep the majority of people in their homes. It is not just about GP services. Public health nurses, community intervention teams and all the other elements need to be bolstered within primary care to keep people out of hospital. This would allow hospitals to look after complex and acute cases.

We need to challenge existing work practices within general practice and in hospital services. There are work practices which, if they were streamlined and integrated with primary care, would act much more efficiently. It is important that the committee starts in the right direction. If we head off in the wrong direction we are going to be in serious trouble.

While activity based funding is important we need to move to a model of outcome based funding. Rewarding lots of activity which may not be productive is not the way to go about it. We should reward productive activity. The committee has also spoken about the inverse-care law where people who need health services most get them least and those who need them least get them most. In deprived rural or urban areas the services are not available to match the need while in affluent areas there are more doctors and GPs. I am not saying that those people do not also require health services but they are probably less in need of them than people in more deprived areas. We must consider how we populate our general practice and our health services in general with regard to supplying for the need rather than for the numbers of patients.

In general terms, there are a number of things we need to do to improve our health service. One of them is the recruitment and retention of staff such as GPs, nurses and senior and junior hospital doctors. We need to create a health service that attracts these people and keeps them in Ireland. We are producing fantastic health professionals but we are letting them leak away because they have trained in a service they do not like, is overburdened with work and offers no job satisfaction. They are leaving. We need to change that and to address it very quickly. We need to increase our bed capacity and to utilise our beds better. As the Minister suggested, delayed discharges are a problem. Shorter bed stays and people not being in hospital at all by being looked after in the community instead are solutions.

We need to increase access to diagnostics, which has been a very common theme in the debate. Diagnostics in hospitals tend to operate between 9 a.m. to 5 p.m. five days a week. We need availability to ultrasound scanning, CT scanning and MRI scanning seven days a week. It makes no sense that the diagnostic services close down on a Friday evening at 5 p.m. We need to bolster our diagnostics because it keeps people out of hospital. If we can diagnose a problem without sending people to a hospital service, we keep them away from the hospital and only send them if it is necessary.

As I said earlier, we need to alter our work practices. That is crucial in the integration of primary and secondary care. We need to streamline our practices in order that unnecessary work and duplication of work are not undertaken. Integration of primary and secondary care with nurses, primary care teams, community intervention teams, adequate home help hours and home care packages is crucial in taking people out of hospital and preventing delayed discharges.

HSE management is difficult to understand at times. It is convoluted, complicated, disjointed, opaque and difficult. We in the medical profession see decisions and cannot understand why they have been taken. The reason we cannot understand them is that we have not been involved in the process of making those decisions. Integrated community teams will get over that and iron out problems before they develop.

We need to develop and improve IT, which was referred to again yesterday. We also need to improve communication. We need to have access to patients' records in the cloud, as I referred to it this morning, in order that the GP, the hospital consultant, the junior doctor and the public health nurse, while taking data protection into account, can access a patient's record and maybe prevent unnecessary admissions to hospital and unnecessary access to diagnostics. Communication is the key on that.

This is a wonderful committee and when the report comes out in January, I hope it will be revolutionary in changing our health service.

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