Michael Harty (Clare, Independent) | Oireachtas source

He should visit them in an unsanitised way. He should talk to front-line staff. Quite often, if there is a problem in a hospital, when one talks to the junior staff or the lady who works in the canteen, they can say what is happening in the hospital and, of course, higher management will have its own view. If one talks to people who experience things every day, one will get a far greater feel for our health service.

The CEO of the HSE, Tony O'Brien, has commented on the report. It is important to read it into the record. He says it is a once in a generation opportunity to reform our health service. He says our service is no longer fit for purpose and has outdated structures and practices. This report requires unprecedented co-operation, collaboration and integration, and "unprecedented" is the word. There must be a huge cultural change in how we look at our health services. There should be a political and a societal consensus that this needs to happen. That is very important, and an important part of this report is that there must be political buy-in at the highest level, at the level of the Taoiseach and at the level of the Minster for Health. It must be driven forward by very strong political buy-in. In concluding, Mr. O'Brien said there has to be a constructive debate, and I know that the Minister is going to start a constructive review of the report, but there must be a constructive debate on how this programme is implemented. It is a reform programme for the entire health service. The Minister must look at it as a whole programme rather than picking bits and pieces. It is the entire health service. It must be looked at globally. It is a single-tier, public service, delivered on priority need, not on the ability to pay.

One of its tenets is a shift from hospital-centred service to community and primary care-centred service. That is critically important. We have had a huge change in our demography and, as the Minister will understand, the hospital system cannot possibly cope with the amount of chronic illness that is developing as people get older and with the multiple co-morbidities that people develop in older age. We need generalists, GPs and public health nurses, and people on the front-line in the community to look after those people properly. Of course, we need specialised hospital services, but those should be allowed to work for complex cases and urgent cases that require hospitalisation. Our hospital services are overwhelmed by care which could be delivered in the community much more effectively with much better outcomes for patients. Community services are what people want. We need to shift away from everything being concentrated into hospitals and recognise that hospital care is under severe pressure, with a bed capacity issue. Why do we have trolley queues and an ever-lengthening waiting list? It is obvious. I know a bed review is under way but we must increase our hospital capacity.

Another major reform in this programme is to disentangle private care from public hospitals. Ireland is unique in Europe that our public system is dependent on private medicine to fund itself. Some €650 million comes into our public system annually from delivering private care in our public hospitals. That is a fundamental change which we must untangle. The delivery of private care in our public hospitals is an obstruction to reform. It provides perverse incentives for hospitals to maximise money from insurance companies and a perverse incentive to consultants to treat private patients and, in some cases, to prioritise them above public patients.

We need to reform our GP services. I have spoken to the Minister on this on many occasions. We need a new GP contract. General practice has been gutted by the financial emergency measures in the public interest, FEMPI. There was a 38% reduction in the money to run practices. That is not GP income. GPs are ageing. The average age of GPs in Europe is 57 years. In Ireland, 33% of GPs are over the age of 55 years. Unless these issues are addressed, one cannot transfer care from the hospital service to community service. We need a new GP contract. I have often told the Minister that the process of negotiating the GP contract is fundamentally flawed. He has entered into a series of negotiations with just one organisation. There are two organisations and it is fundamentally flawed if he continues in this way. If we are to transfer services from hospital to community, we need GPs, and unless there is an acceptable contract that cannot happen.

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