Colm Burke (Fine Gael) | Oireachtas source

I welcome the Minister of State and thank him for the comprehensive overview. It is important to thank everyone in the Department, across the HSE and everyone involved in the provision of health care which is always demanding.

It is important to begin on a positive note. We regularly speak about waiting lists. It is right that we raise the matter and try to deal with it to make the service more efficient. Nevertheless, we should recall the figures. There are 3.2 million attendances in outpatients departments annually, or 63,000 weekly.There are 1.2 million attendances in accident and emergency departments, which is 23,000 weekly, and 16,000 patients attend hospitals each week for day care procedures. Although a large amount of health care is being provided across the board there are still bottlenecks in some areas so it is important that we deal with them.

While I welcome the increase in the budget, my concern is the use of that increase. We must ensure that we deal with the areas where there is an urgent need for reform and improvement. I have raised this issue previously. There was an increase in the budget over the last two years, but there was also a substantial increase of over 2,000 in administration and management from December 2014 to April 2017. At the same time there was an increase of only 39 in the number of public health nurses. That imbalance should not arise. When we provide additional funding it is important to ensure that we are also providing additional people on the front line. There is a need for an urgent examination of management within the HSE and of why certain places appear to have difficulty with retention and continuity. As I have pointed out previously, I am aware of one hospital that has had ten managers in 18 years. There is a problem if that is occurring. Either the pay or the supports are inadequate, but nine people have moved on and the hospital is now on its tenth manager. This is not a small facility. Something must be done so that when such an issue arises management at senior level in the HSE can respond to it. If there is no continuity in management, there will be a problem.

Another huge concern for me is the development of further facilities in the Cork area. My colleague spoke about the rehabilitation services. It is 15 or 20 years since we first talked about opening a rehabilitation unit in Cork. There is a need for such a unit in the Munster region. It could be included in the development of a single major new facility in Cork. The Fitzgerald report in the 1960s suggested that Cork should have two major hospitals. We built one but we appear to have forgotten about the second. The national development plan should include the provision of funding for a new state-of-the-art medical facility that not only caters for the increase in population in Cork, which has increased by over 130,000 in the city and county over the last 30 years, but also for the increase in population in the Munster region. That is extremely important. Rather than obliging people to transfer to Dublin where the expertise is, we should also grow that expertise in Munster. The Dublin facilities are already under substantial pressure.

An issue that has come to light and has been discussed extensively over the last two or three years is support for general practitioners. The report published by Trinity College in the last few days must be carefully examined. It studied a number of jurisdictions and how to develop and provide the necessary supports for general practitioners so they can provide services and, as a result, keep people out of hospital and reduce the number being referred to hospital. It also examined the issue of e-health. This is now in the Cork area and is also being introduced in the rest of the country in respect of maternity services. The system is becoming computerised. It is up and running in Cork and Kerry and there is talk of developing it in Dublin. It is about ensuring that all the management of this area would be computerised. I am aware that there was an initial problem in Cork. While the system was put in place and was up and running for the patient and the hospital, there was a disconnect in the system for general practitioners.

The report, which was published last Monday, highlighted the need for connectivity between hospital services and GPs. In one of the countries studied, Israel, patients can go online and get access to their files. Denmark and Germany were also studied. We are way behind in that regard. While the roll-out of new services is important, it is also important to engage with modern technology and ensure it is in place so GPs can get access to it. That access is not just about referral and getting the results of the work done in the hospital, it is also about getting diagnostic reports. In a huge number of cases the GPs know exactly what is wrong with their patients but they must have it confirmed by getting access to diagnostic services. This must be given priority.

We also must consider the funding for GPs. My understanding is that it is 4.5% of the overall health budget. That must be examined if we wish to keep GPs in this country. My colleague, Senator Swanick, raised the number that will retire from the service. I was in Plymouth recently with the National Association of General Practitioners. We were in one area where all the GPs who were serving 20,000 patients handed in their contracts and walked away from the practice. They could afford to do it because they knew they could get jobs somewhere else. The local hospital was forced to employ other GPs to ensure some level of cover was provided. That is a challenge this country will face in the next five to ten years unless we start to deal with the concerns of GPs. It is extremely important to deal with those in the new contract for GPs.

Finally, I wish to raise the issue of respite care. I received a report from the HSE in the last two weeks. I refer to respite care not just for elderly people but particularly for people with intellectual and physical disability, where parents are caring for children who are now adults. We have a huge ageing population of carers who have been looking after their children for 30, 40 and 50 years. The HSE has identified a need for 2,244 extra respite places between now and 2021. We must prioritise that and see where we can develop at least 500 new places per year between now and 2021. I ask the Minister to give priority to that.