James Reilly (Dublin North, Fine Gael) | Oireachtas source

I will invite various speakers from the HSE and the Department to answer some of the specific questions about which they are more knowledgeable. I will address Deputy Kelleher's questions first. He is concerned about a downgrading of services as a consequence of hospital grouping. On the contrary, the hospital groups will have local knowledge and autonomy which will enable them to decide where the services are best placed in an individual area for the people whom they serve. He is quite correct and I do not wish to be confrontational. The plan for the mid-west region was a good plan at the time but it was not executed properly. With respect, the previous Government removed the services from Nenagh and Ennis before the supporting services were in place in Dooradoyle. We have been at pains to avoid that and to ensure simultaneous exchange of services so that the replacement services are in place simultaneously and the capacity is in place to deal with the consequences of the removal of services.

I will give an example of the current situation; no one has raised this example but I am happy to refer to Navan. There are accident and emergency departments within a short radius in Cavan, Drogheda and down the motorway in James Connolly Memorial Hospital. I have made it very clear there will be no change to that accident and emergency department until the capacity exists in the other accident and emergency departments to take the additional workload. That remains the position. Deputy Kelleher referred to issues relating to the maternity hospitals. The KPMG report indicated that maternity hospitals should be co-located with adult hospitals in the interests of the safety of pregnant mothers. That is also my view and we are pursuing that policy. A maternity hospital will be co-located with the children's hospital. Holles Street hospital will be relocated to St. Vincent's hospital. The Rotunda hospital will be relocated as will the maternity hospital in Limerick and maternity hospitals elsewhere. There will be a need to review the overall number of maternity hospitals and the services they provide. Deputy Kelleher asked who will monitor these trusts to ensure they are held to account. The Minister for Health and the Department will be answerable to the Oireachtas. More work is required on the question of what is to replace what I regard as a democratic deficit that currently exists with the removal of the health boards. I was concerned about this issue long before I was involved in politics because I could see the value of politicians being able to hold the system to account at local level.

Deputy Kelleher and other speakers referred to Tobacco Free Ireland. I take the opportunity to thank everyone for their support. My personal, political and professional views are well known. We know this is a killer product which kills one in two persons who use it regularly. This is an astonishing bald fact which we cannot ignore. We cannot resile from this fight which we must take to the tobacco companies. We must protect our children from ever taking up this habit. As I have pointed out previously, once one is addicted, one is unable to exercise choice. I commend and congratulate the courage of Mr. Gerry Collins and the current television advertisement.

On the issue of obesity, I see Mr. Chris Macey of the Irish Heart Foundation, is in the Gallery today. He has spoken about the impact of obesity in terms of diabetes, cardiovascular disease, strokes, heart attacks and so on. Obesity shortens people's lives. Again, we have a duty to put in place systems to protect children in this regard. One example of this is the Healthy Ireland initiatives which we have introduced right across Government. The Department of Health cannot do this on its own. As I mentioned the other day, we are the first Government to appoint a civil servant at principal officer level to oversee this issue and ensure there is co-ordination between the Department of Health, the Department of Education and Skills and the Department of Children and Youth Affairs. It is an issue that will require continuous innovation and new initiatives to address it.

In terms of primary care, people are very fond of saying that a particular service is in crisis. In this instance, we are told that GPs are leaving the country in their droves. The reality is that there was always a certain number of doctors leaving the country. In fact, I suspect that more left in the past than are doing so now, because they could not avail of a GMS contract. We are the first Government to address that restriction by ensuring that any suitably qualified physician can take on medical card patients, rather than having to wait five years as was the case previously. Since that initiative was implemented, 246 new GPs were brought in under the scheme. Indeed, the overall number of general practitioners has increased in recent years. As at December 2012, there were 2,600 in active practice, full and part-time, and some 300 working as locums. Of these, 2,353 were contracted to provide services under the GMS scheme. This compares with a figure of 2,098 on 31 December 2008, some 2,136 in 2009, and 2,258 in 2010. In other words, there has been a steady rise in numbers over that period. We do not have the up-to-date figures for 2013 but, as I said, an extra 246 doctors have come into the scheme under the new regulations. In addition, and in fairness to the previous Government, the number of GP training places was increased in 2010, an initiative we support.

There is no question of a financial collapse in general practice. I am aware that some practices are in difficulty because they invested heavily in new premises. They were right to do so and are deserving of support. Nobody wants to see those practices fail and we will do everything we can to support them through new models of practice and a new GP contract which rewards those new practice models. We must bear in mind, however, the OECD report published some years ago which showed that Irish GPs were the best paid of all the countries that returned figures. Notwithstanding the reductions in remuneration under the various financial emergency measures in the public interest, I am given to understand that a forthcoming updated report will show there has been no substantial change in terms of the relative position of Irish GPs when it comes to remuneration.