Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I welcome the contributions of all speakers to the debate. It is refreshing and encouraging to have a health debate which is focused not on health problems but solutions. That is a real step forward and it is the general approach that has underpinned the committee's work.

We talked about a number of common themes. One of the most surprising things we have learned through the work of the committee is that there is common ground not only among members of the committee but also among all groups, individuals, researchers and so on. That is the basis on which we hope to build the consensus we are all seeking.

One of the most common themes is the integration of services. In other words, there is a need to integrate primary and community care services with acute hospital services to ensure a shift of focus and activity away from acute hospitals where it is most expensive to the community. That, in the main, is what patients want. They want to receive services locally. We know that approximately 80% of health needs can be met in the community within primary care services. That is where patients are happiest and we get the best health outcomes. It is also where we get best value for money; therefore, it makes sense on many fronts.

The fact that we have a two-tier health system greatly militates against the critical integration required. The concern is that this or a future Government might move to pursue a policy of developing hospital groups into trusts as this would further disintegrate the health service. We would be foolish not to learn from the experience in the United Kingdom and other jurisdictions where elements of the health service have been hived off on the grounds that greater efficiencies and value for money will be achieved in privatised models or independent trusts. We know that where this has been tried it has not been the experience and that taking this approach has generally worked out to be more expensive. We would be foolish not to heed that experience.

Another issue about which I am concerned in what is being proposed is the organisational structures of the HSE and current hospital groups. Leaving aside the issue of whether hospital groups should develop into trusts, that we have six hospital groups and nine community health organisations that are not aligned does not seem to make any organisational sense. It militates against the objective of having good integration of services.

How can we measure activity and outcomes in geographic areas if we cannot define the area and state this is how much is being spent on the hospital sector and this is what we need to transfer to the community and primary care sector? Let us measure this transfer of resources and better value and outcomes. It is very hard to do this if the hospital and community health organisations are not aligned. Nobody wants to engage in further churn in the health services, because constant change is what has done a lot of damage and caused such huge uncertainty and lack of morale in recent years but, at the same time, we must pose the difficult question on whether it makes sense to go ahead with the type of very disjointed, disconnected and disintegrated organisational structure that is being put in place at present. This certainly needs to be addressed if we are to move to a situation where we can profile areas and their level of need, and match resources and services to this need and ensure we get best value for money by having strict data collection and measurement of outcomes. It is hard to see how this can be done in the existing proposals.

A point we have picked up in recent days in particular is the importance of legislation to underpin eligibility. This has been the problem with the health service. The Department for Social Protection has clear legal eligibility criteria for various payments, but in health we do not have clarity on eligibility. We must legislate for this. The point has been made to us very clearly that if we start with the legislation and establish people's eligibility, identifying the exact services for which they are eligible, by and large the rest will follow. If there is a legal entitlement to eligibility for certain services those services must be put in place. This cannot be done overnight of course, much and all as we would like to see it being done very quickly, because it is a very big ship which needs to be turned around. This is why we speak about a ten year perspective. This cannot be an excuse for delaying reform. We need to put in place the building blocks and make the reform happen as quickly as possible. This is our responsibility to the people we represent, and we would be failing in our duty not to avail of this historic opportunity we all have.

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