Colm Burke (Fine Gael) | Oireachtas source

I thank the Minister for his presentation. He referred to €25 million for primary care during his presentation. One of the issues in relation to any health report and change is about focusing on the primary care setting. At present a huge amount of work is being referred to hospitals and GPs claim, and rightly so, that they do not get enough support. I am concerned about the ongoing GP contract negotiations because they seem to be lasting a while. I presume contract negotiations must take into account the recommendations in the Sláintecare report on how we should progress.

I recently travelled to Plymouth with the National Association of General Practitioners and visited a number of GP practices. One of the practices was very pleased that the time patients had to wait to see a doctor had been reduced from 15 days to eight. On our visit we also discovered that all of the doctors who worked for a large GP practice of over 20,000 patients handed in their contracts and walked away. As a result a local hospital had to recruit GPs to fill the void. I do not want such a scenario to happen here in Ireland. Therefore, it is extremely important that we progress and develop primary care. We must ensure we adopt a joint approach rather than being dictated to from the top down.

I would like the Minister to indicate the current state of the negotiations and the timeframe involved for the GP contract. Let us remember that the last contract is over 40 years old so there is a need for constant review. The contract is a fundamental part of our health service. As the chairperson mentioned in her opening statement, we cannot leave the negotiations to continue ad infinitum. I had the privilege of serving on a State board for ten years. I was involved in the contract negotiations for one particular aspect but, unfortunately, it took us 11 years to make progress. I understand that the negotiations for the last consultant contract between the HSE and the Department took between eight and ten years. Can the Minister tell us the current status of the GP contracts, the timescale and targets? I know he cannot be very precise as negotiations are ongoing but we need some indication on that issue.

I have expressed my personal concerns about the following matter to the Minister over the past six months. On the one hand, we are talking about a major ten-year plan. On the other hand, there seems to have been a free for all in terms of hiring staff for the HSE. More than 2,000 additional people have been hired in administration and management between December 2014 and April 2017. Over the same period only 39 additional public health nurses were employed.

In the same time, only 39 additional public health nurses were employed despite over 2,000 being taken on in administration and management. That leads me to the issue of management, an issue that arose in respect of the RTÉ report last night. My colleague raised the matter of specialist registrars not having the qualification but being paid as consultants. Have we clear qualifying criteria for the people we install in management in hospitals? I am aware of one hospital, and I have raised this with the Minister, that is now on it tenth manager in 18 years. There appears to be a constant roll over of responsibilities within the HSE whereby one is in a position for two years and then one moves on to another job. When the new person arrives, he or she can say he or she was not in that position when a decision was taken. There is a delay in the decision-making process as well because the new person in the position has to familiarise himself or herself with the issue involved and can find that he or she is making no progress.

I am aware of a case recently where a GP came forward with a comprehensive proposal for cutting the cost of a particular service for the HSE. However, he threw in the towel after 18 months because every time he went to meet somebody from the HSE to discuss it, a different person arrived and nobody could make up their mind. This was about a saving whereby GPs would provide an additional service at a far reduced cost compared with the cost of people having to go to hospital. That is an issue we also must examine when considering reform in the health service. People are going into positions but the situation does not change after six or 12 months, so when somebody new arrives the person can say he or she was not there when something happened. That is happening in the health service as well when there is a change in Ministers. That culture appears to have transferred down the line. It is a problem we must resolve. When dealing with the management issue we must have a proper structure for dealing with that aspect as well.