James Reilly (Fine Gael) | Oireachtas source

I welcome this debate. I listened from my office to what the Minister had to say and to the other contributions. As the Minister is on the record as saying, it is unacceptable that our citizens must wait such a long time to get treatment. There is a long waiting list in outpatients. It used to be referred to as the waiting list to get on the waiting list. For the first time the waiting list has been properly tabulated and people have been made aware of it. There is a waiting time and waiting list for people to get in for surgery. There was a policy, rightly, of treating people with cancer and urgent cases first and then everybody else in chronological order. That measure was not implemented in many cases.

I know, just as Senator Swanick knows because he deals with the following in his surgery every day, that patients who are treated electively in a planned way will always have a better outcome from that than they will if they are left on waiting lists for inpatient treatment and their condition develops into an emergency. That is a real concern for patients, citizens and parents.

I welcome the Minister's comments about children. Unlike adults, children grow and the window of opportunity to intervene is very limited. If a child does not get an intervention at the right time, the result can never be as good.

I wish to point out again that no part of the health service operates in isolation. While we focus today on waiting lists for inpatient treatment and we focused several weeks ago on the most acutely ill lying on trolleys in hospitals, to attack either problem in isolation will not work. We have to look at education and advise people to see their doctor or public health nurse. We must get away from the old culture of only going to the doctor when sick as opposed to going to the doctor to keep well. That is why we now have more screening and why we need a new GP contract which emphasises the policy of resourcing and rewarding GPs for doing such work. That is who we will prevent illnesses and intervene earlier, thus keeping many people out of hospital and away from an operating theatre.

Equally, we need to do more day hospital work. Much of that work is being done at the moment. As I said in the House before, there are great examples of day procedures such as gallbladder procedures, hernia repairs, plastic surgery and cataract procedures taking place in Nenagh, Ennis, Louth and many other places. The list is quite considerable. Endoscopy can be done outside of a major hospital. All these procedures can be done in day hospitals. Sadly, this work is lacking in Dublin. We do not a day hospital system in Dublin. We badly need one in Swords and north County Dublin to service the large population between the Mater hospital, Beaumont Hospital, the hospital in Drogheda and Cavan General Hospital. Two of these hospitals have national specialties and regional specialties. Despite this, we continually have situations where day surgeries and other surgeries are cancelled due to an overflow in their accident and emergency departments. I ask the Minister to turn his mind to the pressing need for new day hospitals throughout the country, particularly in Dublin and especially in north County Dublin.

We must examine what happens when people leave hospitals. We must analyse the need for step-down facilities for a short stay while people recuperate, as alluded to, and for a longer stay where necessary.

Again, we have too many people in the system operating at the wrong level. We have consultants doing work GPs can do and we have GPs doing work nurses can do. A classic case, if we want to prove the point, is colonoscopy. Advanced nurse practitioners perform colonoscopies. Nurses have tremendous skills and are excellent at delivering care. Many patients find it much easier to speak to a nurse than a doctor. That is not gender-based because patients find it as difficult to talk to a female doctor as a male doctor. I do not know the reason but the fact is nurses are a wonderful resource. Nurses must be given a greater role in prescribing and running protocols in primary care as well as more work in hospitals and more freedom to allow them do work currently done by doctors in hospitals.

Senators have touched on the subject of recruiting nurses. It is very difficult to recruit non-consultant hospital doctors or junior doctors. They are leaving this country mainly because of the manner in which they have been treated by the system and sometimes by their superior or senior doctors. I have asked the following question numerous times. Why does it take 12 years for a qualified doctor to become a specialist in this country? It only takes six years to become a specialist in the United States of America and other jurisdictions.

The health service has a myriad of problems but, without question, they can be addressed. If we keep doing the same thing in the same way and expecting different results, then as Einstein said, it is the definition of insanity. We need to change things. Many changes have been made.

I want to correct the record. Senator Boyhan spoke about the National Treatment Purchase Fund, NTPF, and inferred that there had been some interference by the Minister. The NTPF was not discontinued and its board was not dismissed. The NTPF was asked to do a different job because we did not have the money to fund it and I will not score political points about why that was. The reality is we did not have the money. The small bit of money we did have we put into a special delivery unit, which is an entirely separate entity.With that small amount of funding, the NTPF, with the co-operation of front-line staff, made a huge difference. The numbers on trolleys were reduced by one third and waiting times for inpatient treatment fell to eight months. This is not just about money, although money was a real problem then, particularly in 2013 and 2014. There is more money going into our health service and I welcome that but I do not want to see it going down a black hole. I echo what has been said here about management and accountability but I also want to remind people about the amount of money we spend on training and supporting doctors and nurses in terms of continuous professional development and so forth. What do we do for managers? Many are plucked from administration jobs, put into management and then left there without the supports to allow them to continue to learn and to do the job that we want them to do.

I will conclude by saying that I hope the additional money that has been allocated to the health service will have the required impact and lessen the suffering of our citizens. We do not want to see our loved ones, families, friends and members of our communities suffering when we know are spending so much money on health. The NTPF is welcome in terms of having additional funds but it is only a temporary sticking plaster. If we do not address the core of the problem, we will never fix it.