James Reilly (Fine Gael) | Oireachtas source

I congratulate the Leas-Chathaoirleach on his recent election to the post and I also congratulate the Cathaoirleach, who is not present, on his appointment because this is my first opportunity to do so publicly. I also congratulate, Senator Buttimer, the new Leader of the House and, indeed, all new Senators.

There is much I would like to say but I agree with everything that Senator Swanick said, much of which I have said in the past. I also am delighted to have heard the Minister speak in the manner he did. It is important that as we celebrate the centenary of 1916, which started a process that led to our independence, we remember what the Proclamation said about equality and treating all our citizens equally. One of the most pressing needs around equality is the right to health care and access to health care when one needs it, not when one can afford it. That has been at the core of what we have sought to do. The ten-year plan and the cross-party committee will decide what we want. Many of agree on the what but the how and the when cause divisions. We want a fair health service that treats everybody equally and is there for them when they need it.

The points I wish to make I have made in the past. I always had a mantra that the patient should be seen at the lowest level of complexity that is safe, timely, efficient and as near to home as possible. The nearest place to home is usually the GP's surgery. We need primary care centres to deliver the excellence of care that GPs can provide in excellent surroundings and that sends a message. I agree more access is needed to diagnostics but it also needs to be ensured people are working to their level of competence and that GPs are not seeing patients that nurses could see, nurses are not seeing patients other paramedics should see and consultants should not be examining patients who could be dealt with within the primary care system. There is a huge opportunity with a new cadre of nurses coming through who are interested and energised and want to provide different services and who are well capable of learning those skillsets.

No part of the health service is isolated.Senator Swanick addressed this in his comments. One cannot fix what is happening in accident and emergency units unless one fixes what is happening in primary care, which equally is dependent on what is available in the community, and the full circle is completed by rehabilitation.

Senator Swanick talked about elderly patients. I am very concerned about the fact that there has been a movement towards a medical model in nursing homes which was arrived at by the need to address burdens on families and society and concerns surrounding the safety of elderly people living on their own, as opposed to a service and a place where we address their needs and help them to get the best out of life as they inevitably grow more frail. That is something that we must continually keep readdressing.

I was struck also by the Minister's comments regarding disability. Senator John Dolan would be the first to say that people with a disability often ask, "Why am I here? I am not sick; I have a disability." It is an entirely different problem. We must address this big issue, which has always been a huge tension between the excitement of investing more in cardiac bypass and stenting versus longer-term investment in education on exercise, obesity, alcohol and tobacco. That dynamic is always there and is one that is very difficult for politicians to address. I have been critical of politicians on this island, in Europe and at the UN for being more likely to go for the big bang of the new cardiac unit rather than the slightly softer matter of more PE in schools, exercise and education so that people realise one can prevent many illnesses. It is no longer a threat in the western world to die from infections; the big threat is from chronic illness and non-communicable diseases. The broader issues surrounding that are influenced by child care, and we must have a vision in that regard too. I believe the Government has started on that route in making child care more affordable, giving every child an equal chance in life. Again, this is the big problem for us. We all know the things we want, we all speak to them, but we must acknowledge that funding is finite and that if we invest over here, we cannot invest as much over there. I therefore return to the argument about the new CAT scanner versus a new public health initiative.

Do I have a few more minutes? I have about one minute.