I will take some of Deputy McManus's key questions. We should focus on quality and safety in our health care system. If we start to do that, as they are doing in the United States, we will get somewhere. However, we must define quality in health care and we must know what delivers safety before we begin to address the issue. It bothers me that there is not enough emphasis on this. In fact, it should be wholly about that. I remain concerned that the concepts which drove the Hanly report still exist quietly in the background within the people who run the Department of Health and Children and the health service. Many people believe in these concepts.
One of the main reasons for the Hanly report is financial. The drive behind those concepts was that one cannot have 37 acute care hospitals in the country and be able to provide the funds to keep them all open. That is the driving concept and creates much difficulty for me as a medical doctor working in a smaller general hospital. We cannot get away from financial concerns and the trade-offs that must ultimately be made. However, the drive behind the concept was financial. That issue has arisen since the original Fitzgerald report. How will we finance our acute hospital services? The vast bulk of people in our hospitals are older people. As a medical professional working in a small hospital, I met 92 year-old patients who, if the Hanly report was implemented, would end up in University College Hospital Galway, more than 50 miles away from their relatives. It seems wrong that we should produce a report that would result in these people being moved far away from their homes. We need to have treatment as close to home as possible, because the bulk of the people that need treatment are older people. How can we do that and keep smaller hospitals open? We must have proper facilities to look after patients. They need to be treated in appropriate surroundings and with appropriate equipment, so that a physician can investigate that patient properly. If we practice the appropriate evidence based care we will get a good outcome for the patient, no matter what the size of the hospital.
We know we cannot do everything in small hospitals, such as brain surgery. That is specialised care and we have no objection to that. However, 95% of patients that come through hospital doors can be given the appropriate facilities and staff in smaller general hospitals. As the population gets older, we will need to have these acute care services provided locally. It is absolutely crucial. With advances in information technology, this can be done. Tele-medicine and tele-health will be a crucial part of how we deliver quality and safety. This is particularly the case for a system that is short of highly qualified staff. This is already being done in the US and in Scotland. There is no reason we should not do it here. Working in Portiuncula Hospital, I often feel it would be nice to speak to a colleague in Galway on the television about the care of a patient in my hospital. This can be done if we focus on it. Information technology, such as decision based support tools, will assist the people who are caring for patients and can make a dramatic impact on providing quality care. Much more money needs to be spent on information technology.
In Portiuncula Hospital, we were fascinated to receive a request from University College Hospital Galway asking that we train their medical students. The hospital was aware that more trained doctors were needed in the health service. These students cannot be trained properly in specialised hospitals — they need general training, which can easily take place in smaller acute hospitals. When medical students in Ireland and the UK are asked how they feel about their education in smaller hospitals, our hospitals achieve a higher score than the university hospital. It is therefore crucial that we keep the smaller hospitals open. We will have to integrate the primary care sector with the secondary care sector. If we do not do that, we will never have the excellent health service we all want. It is very frustrating that our primary care service has virtually no integration with secondary care. Some health maintenance organisations in the US have a strategy for close integration between primary and secondary care. Once we do that here, we will begin to deliver a quality health service.
A report from the UK has shown that the cost of providing two ambulances equates with the cost of looking after one ward. Ambulances cost much money to run and to service. Under the Hanly report, a patient suffering a heart attack in Athlone, 15 miles from Portiuncula Hospital, would be taken to University College Hospital Galway, bypassing our hospital. That patient would be cared for in the back of an ambulance by a paramedic. Would it not be better for that patient to be treated in Portiuncula Hospital by a physician with 20 years training in heart disease? It is nonsense to assume that paramedics can provide a service that equates with delivery of an acute care service in a local hospital. A recent report from Canada shows that paramedics providing intubation, ventilation and resuscitation of patients, does not improve the mortality of the patient that has had a heart attack. Defibrillation of the patient as soon as possible is what produces less mortality. There is therefore a limit to what paramedics can do. That is not to say we should not have paramedics. However, there is evidence to suggest that the longer one delays in getting a trauma victim to the hospital, the mortality increases. We need to look closely at the medical research there before we decide that this is the way to go. With due respect, patients being treated by paramedics in ambulances on bigger and wider roads will not solve our problems.
