Gerald Nash (Labour) | Oireachtas source

I am pleased to contribute to this important debate. I first want to wish my colleague, the Minister of State, Deputy Corcoran Kennedy, every success in her portfolio. In the previous Oireachtas we both had different roles but I very much enjoyed our engagement in terms of my role as Minister of State with responsibility for business and employment and her role as the very successful Chairman of the Joint Committee on Jobs, Enterprise and Innovation. I extend my congratulations also to the Minister, Deputy Harris, on his appointment. It is not overstating the case to say that we as a society very much depend on their success as respective Ministers in their portfolios, so there is no extra pressure.

For some time I have stated privately and publicly that the future direction of our national health service requires that we have a long-term, consensus-driven strategy and approach to our service that has a genuine role for all stakeholders in the process. That means everybody across society, not just those of us who are privileged to sit in this House and the Lower House. The success of this proposition and the proposed ten-year programme in regard to health services requires all of us to be honest with one another. It requires an honest Government but it also requires an honest Opposition. We need to start with a vision of the kind of health service we want. It flows from that that we must be absolutely clear about how we plan for that and how we resource it. We need to have an honest discussion.

The provision of first-class health care comes at a cost. It is very costly but it is something that is worth paying for. Treatment in acute medical settings is particularly expensive and the operation of our emergency departments is, by definition, very costly. Those of us who do have and will have the need to use our acute hospital services deserve to be treated in a timely and effective manner and provided with the best possible treatment by staff who are supported and valued in hospitals that are accountable and managed by people with the right skillsets and who understand that it is the patient, the citizen, who should be at the heart of health care service provision. They should also accept that their jobs, and the way in which they manage their jobs in hospitals, should be open to the closest of scrutiny.

We are also familiar with the problems experienced in our overcrowded emergency departments across the country. I am acutely aware of the long-standing problems experienced in Our Lady of Lourdes Hospital in Drogheda, my home town, in my constituency.I have been party to many efforts, particularly in recent years, to address that hospital's multifaceted overcrowding problems.

We need to step back and take a clear-headed look at this situation. Many of the problems experienced by emergency departments, and the reason for the bottlenecks in appointments, outpatient services, surgeries and so on in acute hospitals, can be traced back to the lack of prioritisation of the provision of integrated primary care services and of the notion of prevention being at the heart of the life of a healthy society. Remarkably, Ireland has the only EU health service that does not offer universal coverage for primary care. We have a public hospital system that is largely fed by a private primary care system. This is the perverse way in which the health system has evolved organically since the foundation of the State.

Many sneered at the idea that we would provide free GP care to young children and those aged over 70 years. It was dismissed by some as a political stunt, but it was the start of an ambition to provide such a service to all of our citizens in a move towards a new national community health service. My party's vision for a new integrated primary care service involves the proper integration of GP services, advanced nursing practitioners and allied health professionals and staff being active in community settings treating and managing patients away from expensive hospitals.

If we believe that the pressure on hospitals is enormous now, what will it be like in the years to 2020 and 2030, when it is anticipated that there will be a 40% increase in the incidence of chronic disease in Ireland? To avoid this apocalyptic scenario, we must develop dozens of new community-based clinical programmes that target the most prevalent and complex chronic diseases so that people can get consistent access to treatment and prevention strategies without needing to visit hospitals. This approach would have an empowering effect on patients, liberating them from an excessive reliance on the acute hospital setting.

We cannot afford not to make these step changes in the delivery of services. It is important that we put the primary care vision and the integration of services at the heart of everything that we do in our vision for a health service over the coming years. We can build a consensus on this approach.