Colm Burke (Fine Gael) | Oireachtas source

I welcome the Minister to the House. I am delighted that he is here with us dealing with the health programme, in particular the need for a ten-year development plan for health. It is extremely important.

One of the things that concerns me regarding the whole health care area is why every issue that comes up in the media seems to be very negative in its content, whereas there are a lot of positive things, to which the Minister referred earlier. It is interesting how the HSE report was made available and laid before this House in the last two weeks, yet very little coverage was given to it. I remember being at a meeting not so long ago at which people were saying the health system was crumbling. I asked them what particular aspect was crumbling but the debate went on.

I started looking at the figures regarding what exactly the health service is doing. I raised the attendance at outpatient clinics in Irish hospitals last week. There were 3.3 million attendances which, over a five-day week - most of these outpatient clinics operate five days a week - works out at 63,000 people per week attending outpatient clinics in Irish hospitals, or 12,500 per day, which is a huge number. If one then considers accident and emergency units, it works out at approximately 23,000 people a week attending accident and emergency units. The question is how we work towards first of all making the services that are being provided more efficient, but also, particularly regarding accident and emergency units, how we work towards reducing those numbers so that services are available outside the hospital system.

My colleague, Senator Swanick, raised very important points regarding the issue of GPs and the support for them, and it is also important to realise that GPs over the last number of years have suffered unfairly under the cuts. I remember meeting a number of GPs over the last 12 months who identified that they had suffered cuts of up to 40%, and I am not exaggerating. As a result they find that they cannot provide the same level of service that they want to provide to their patients. One very simple example was given to me. If someone comes into a surgery and needs three stitches in his or her arm, the pack for doing that costs €30. The GP is only entitled to claim €26 outside of the time that he or she puts into providing the care, so the easiest option is to refer the person to an accident and emergency unit. That is just one example of what I am talking about, namely, the inadequate support given to our general practitioners.

I agree with Senator Swanick about the National Association of General Practitioners. All of the medical unions should be involved in negotiations regarding the contract for GPs because this is not a contract for 12 months or two years but a contract that would hopefully be in place for a long time, probably five, ten or 15 years. Therefore, it is important that all of the people involved in this area of providing medical care are involved as regards what that contract should contain.

We face a number of major challenges, and I think the Minister is aware of them, and he has highlighted them already. A simple example given at a presentation by GPs that I attended is that there are approximately 600,000 people over 65 years of age in Ireland. Within 14 years that will be 1 million. A very interesting figure that the GPs brought up, however, is that 51% of all hospital beds are occupied by over 65s. If one works out that ratio, the number of additional beds we would technically require over the next 14 years is quite substantial unless we can improve a number of other areas to make sure we have fewer people having to go into hospital and that a lot of the care that they require can be dealt with outside of the hospital setting. The budget for the HSE last year was €13.895 billion, €3.621 billion of which went to non-statutory agencies.In addition to that €13.895 billion, a huge amount is spent on private health care such that Ireland is now the second highest spender on health care per head of population in the OECD. Are we getting value in real terms? Could we deliver a better service with the money being spent? I believe we could.

Another issue we need to consider and which should be part of the health plan - though many may say it should not - is medical education. We are spending about €90 million per year on medical education. Within 12 months, 60% of that investment has gone out of the country. We need to look at how we can keep our own people within the health service in Ireland and if they want to go abroad for a period, we should at least be able to get them back. This is affecting smaller hospitals in particular. In such hospitals outside Dublin, Cork, Limerick and Galway, the major centres of population, up to 70% of the medical practitioners are non-Irish. They are providing a good service but we should have a system in place that encourages Irish people to stay in Irish hospitals.