Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the Minister of State. As we go through the Estimates for the year, it is looking at things in a historical context to a certain extent as well as everything else and trying to learn from what has been done to date as regards funding and policy itself. In that context, the Minister of State referred towards the end of his opening statement to primary care. There is no doubt that a couple of related issues are being discussed at other fora currently, including the GP contract, which is a critical component of the delivery of health care. That was also alluded to in the Sláintecare report where we talked about the transfer of services from the hospital-centric system we have at the moment to the community by way of bolstering primary care, community diagnostics, therapy and so on. The following is an observation as much as it is a criticism. I think often that officialdom lives in a parallel universe when it comes to what is happening on the ground in terms of investment figures showing increases in home care packages and home help hours. When one drills down into it, one still finds huge problems in trying to deliver the very basics in terms of home help hours. Where a person is deemed to need home help hours to get out of bed, there may only be funding to get out of bed five days a week. As such, the person has to stay in bed two days a week.

We have almost dehumanised our health services in some key areas. It is not a reflection not the people at the coalface, but it seems we do not have that ability to understand in officialdom and through the system what individuals go through in their lives. We have to look harshly at how we assess and view cuts to services or the lack of a service in the first place and the impact that has on an individual's life. I have an 84 year old woman whose husband cannot get out of bed himself. They need a hoisting system and all of that is in place, which she appreciates very much. However, she is only funded six mornings a week. On the seventh morning, every Sunday, she has to get neighbours or friends to help her get her husband out of bed. She only wants 20 minutes. That is an issue that has to be addressed if we are to have any meaningful change of heart in the delivery of health care in primary and community settings. It is just an individual case but it can be extrapolated across the whole are of home care packages, home help hours, access to diagnostics, access to therapy and all of that.

When we talk about primary care, which is the Minister of State's particular area, we talk about extending eligibility for free GP care. While I opposed it at the time, I did so on the grounds that I did not think the GP services in place would be able to cope with what would be thrown at it in the context of the roll-out of universal GP care given the demographics of both the population and of GPs. We are at the crossroads in how we look at primary care and its delivery. We talk about it a lot but we have not resourced and funded it accordingly. The Minister of State refers to the availability of €850 million for primary care, but when one looks at what we expect that to do from a policy and demographic perspective, the two will not match and marry very well. We will end up with a gravely abused primary care system which is incapable of delivering in the key areas the Minister of State has identified from a policy perspective or, primarily, from the perspective of Sláintecare. That is chronic disease and illness, more diagnostics, retention of people in home or community care settings or step-down facilities. That requires a great many more GPs.

I refer to the involvement of GPs in home care delivery and primary care teams and where we are with the number of GPs, the numbers who are retiring, the capacity of the primary care system in general and its funding and the tortuously slow negotiations around the GP contract, if it is even possible to say there are negotiations at all. I am beginning to think this is just window dressing. If negotiations are not moving between the primary actors, namely, the Department of Health and the IMO, others must intervene to push this on. It is the central and most critical issue in terms of how we deliver care in community and primary care settings in the foreseeable future. Obviously, we would like to see a rolling contract that is revisited on a regular basis, but we will have to get the basics right or we will end up in circumstances where no GPs are coming into the system while those who are trained and qualified are leaving. Meanwhile, those at the other end of the scale approaching retirement age will step off because they have had enough. We could end up with a very difficult situation in which policy refers to primary care but everybody is sent to hospital. These are observations but they are important from the point of view of the focus on funding.

There was an RTÉ report yesterday by Brian O’Connell who visited Cork and spoke with GPs and families in Munster on the availability of psychiatric services. The fact remains that child and adolescent mental health services in the Munster region are not what the Minister of State and I would like. Certainly, they are not up to standard for those who depend on them. We have situations in which GPs have no choice where a child attends who is at risk of self-harm, has suicidal ideation or has attempted suicide. He or she must be referred to an emergency department. If that is not done, the person is put on a waiting list. That goes back to my original point about how we dehumanise the health system. It causes trauma to the individual, the family and the medical professionals trying to deal with it that they cannot access any particular service.

The Minister of State referred a few times in his opening statement to the number of people we require to expand the health service. We must carry out a full root and branch manpower assessment as to what we need in our health services beyond the horizon. We talk about training health professionals and it is seven to ten years before some are fully qualified. It requires a great deal of long-term planning but we have not carried it out in enough areas. We have not assessed the demographics and the demands the changing profile of the population will place on health service. We have not determined what professionals we need to meet those demands. That means getting involved with the training bodies and agencies to expand and enhance capacity in key areas. We all speak, for example, about the fact that we will be older. When one looks at investment in training in geriatric services, however, we are not crowning ourselves in glory notwithstanding the fact that we know the population will be quite elderly down the road. That is one key area where a failure to drill down and determine what illnesses like diabetes and obesity, which are evident in the population, will mean.

We do not seem to have enough capacity to assess what our manpower requirements will be, not next year or the following year but in five, seven, ten or 15 years' time. That is something that is never referred to in speeches or in policy other than it being said that we know we need additional doctors. We have never carried out a detailed analysis. The last time such an approach was taken was in the context of the Hanly report on consultants. We need a detailed analysis of all grades - including physiotherapists and occupational therapists - right across the spectrum. I urge that such an approach would be taken in the context of the Sláintecare report and the funding of same or that the Department would independently get someone to carry out a detailed assessment of manpower requirements and then put in place the capacity to train them.