Joan Collins (Dublin South Central, Independent) | Oireachtas source

I thank Deputy Róisín Shortall for proposing the establishment of the Committee on the Future of Healthcare. This is the first time I have been involved in a committee that has collectively tried to grasp the complex nature of the health service. Finding out about its various parts and the way in which it operates is like going into a minefield. At recent meetings of the committee I have been struck by the number of professionals and researchers who espouse the principles of universal health care, including access to services based on need, free care at the point of delivery and equal access to care for all. This is the message the committee has heard from the Irish College of General Practitioners, nurses and others. We will see how the position develops in this regard when we meet other professionals in the health service.

Members have also been struck by the need to use general practitioners in primary and community care services to reduce pressure on hospitals. Many patients should not be in hospitals which should provide surgery, chronic care services and so forth. If care was provided in the community and services were configured correctly, the health service would be transformed. While general practitioners are up for such a change, as the committee heard, 33% of GPs are aged over 55 years - the figure for County Mayo is 55% - which means that a swathe of general practitioners will retire during the lifetime of the future ten-year plan. This puts the spotlight on the crucial need to address the issue of GP training and retention. We must put in place a policy that will take account of geography, deprivation and so forth and encourages and inspires GPs to stay in the country and play a role in the health service. This will require us to think outside the box. We must ensure the doctors we train are not grabbed by other countries because their training is so good and they conduct themselves so professionally. This is a strategic issue that the committee will have to address and it may mean, for example, waiving education fees for general practitioners who stay in the country for 15 years after graduation and buy into the system.

The Irish College of General Practitioners emphasised the need to use electronic medical records. This will be crucial if we are to achieve an integrated health service with information flowing between hospital consultants, general practitioners, practice nurses, physiotherapists and other health professionals.

The Minister will be aware of the special task force set up in the Carlow-Kilkenny area which has been working very successfully with a local hospital. The committee was informed that four or five years ago diabetes patients referred to the hospital for checks had to wait for months. The task force worked with the chief executive of the hospital and others to reduce waiting times. As a result, diabetes patients are now seen within two weeks of being referred to a hospital consultant by a general practitioner. The system has been transformed in four years because hospital consultants have worked closely with local GPs and agencies. The team meets regularly to discuss how to overcome problems. The committee will need to investigate how this approach can be extended to other areas. Hospitals and GPs need to engage with the Carlow-Kilkenny model. Sometimes, however, people protect what they have and do not want to move out of their boxes. This approach will mean that everyone will win if it is done right. Patients will win, which is crucial, as will general practitioners because they will assume responsibility for the overall health of their patients.

Most GPs know their patients from birth and are familiar with their background, their parents and their health history, including their mental health. They also know how active their patients are and have a great deal of knowledge that can be joined up if a patient develops a chronic disease. This is important.

According to Professor Allyson Pollock, the committee must base its work on evidence. Deputy Louise O'Reilly made a point about trust. Professor Pollock pointed out that British hospitals spent 16% of their income on servicing debts.

A further 3% is spent on public relations and a certain amount more will go on staff in the hospitals who work to raise money to pay back the debt. It is a waste of money but that is where it goes. I agree 100% with Deputy Louise O'Reilly that we should be moving away from that trust model. The programme for Government should consider slowing down the process in regard to the proposals from the committee.

The key thing Professor Pollock said was that it has to be underpinned by legislation. In the UK in 2012, following two decades of market incrementalism, the British Government abolished the universal public model by removing the duty on the Secretary of State to provide key health services throughout England. From that point on, there has been a crisis in the hospitals. In England, 75% of foundation trusts are in serious financial deficit. In contrast, no hospital in Scotland is going to the wall because the latter did not implement this and kept hospitals under the health boards. The key point Professor Pollock made was that national health service legislation has to be introduced by any country that seriously wants to drive a universal health model. That Bill will have to be brought through the Dáil and enacted first, not last, so there is a commitment from the Parliament that the necessary legislation will be in place. It is the first step in the ten-year plan. This also came up with GPs in regard to their contract, namely, there has to be legislation in regard to that contract in order to solidify the services they provide. Although I could say more, I will conclude on that point.

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