Michael Harty (Clare, Independent) | Oireachtas source

I thank Deputy Durkan. Before the Minister of State answers those questions, I will put a few questions to him. The Minister of State referred quite often in his opening statement to the Sláintecare report and the need for health reform and the shift from secondary hospital services to primary care services. Is there anything in the Estimates to indicate there is a start in attempting to move from the expensive secondary care services to much more practical and efficient primary care services? Will the Minister of State point out where that is in the Estimates?

There is also reference in the Minister of State's opening statement to the expansion of eligibility for medical cards and free care to those under six and those over 70.

There has been an expansion in delivering medical cards to people in receipt of disability allowance. There is now a proposal to increase eligibility for those who receive carer's allowance. However, there is limited capacity in general practice to deliver these services. General practice is at its maximum, yet eligibility is increasing without any recognition that there is a huge manpower crisis. I do not expect the Minister of State to negotiate the GP contract across the floor of the committee room this morning but there is huge difficulty relating to GP manpower. The Minister of State would have heard it at the weekend. How can we propose to shift from secondary care to primary care if we do not have the GPs to deliver the service? General practice is at maximum capacity and many areas are facing the possibility of not having a GP at all. Many practices have closed their lists. We need to move to a new model of care and the GP negotiations are critical. They have been ongoing for two years. The Minister of State said they are a challenge and hope to deliver a contract by the end of the year but we have been listening to that for two years. Perhaps the Minister of State could address the accelerators to develop that contract.

Every part of our health service is interconnected, so if we fail to invest in primary care, naturally, people will gravitate towards secondary care. Therefore, we have trolley queues, increasing outpatient waiting lists and increased waiting lists for inpatient elective care, so there is a connection. Will the Minister of State outline his view on how those interconnections can be changed so that primary care can relieve the pressure on our hospital service?

Will the Minister of State address bed capacity? He identified a number of capital investments in his opening statement. One of the proposals in Project Ireland 2040 was to build three elective hospitals which would just deal with elective care and would not be overwhelmed by patients coming in through casualty departments and displacing people who are waiting for elective treatment. It is not mentioned in the Minister of State's opening statement but it is in Project Ireland 2040.

Model 2 hospitals are coming under severe pressure regarding recruitment and retention, particularly for nurses and medical specialists, because they are seen as unattractive places to work. There is a huge number of consultant vacancies - up to 400. Many of those are in model 2 and model 3 hospitals. Certainly University Hospital Kerry in Tralee is under severe pressure at the moment because it is losing three of its major specialists and is having difficulty recruiting. Ennis Hospital is having difficulty in recruiting geriatricians, so there is a difficulty in recruiting people in specific areas in our health service. Perhaps the Minister of State might address that.

The Estimates contain an allocation of €1 million to development the Sláintecare office and the implementation office. Will the Minister of State refer to how this is progressing? Regarding the funding of our hospital services, €670 million comes from private health insurance. This figure seems to be dropping because private health insurance companies are encouraging patients who come through emergency departments not to designate themselves as private patients because it will not give them any additional care. This is leading to a reduction in the amount of money coming from insurance companies to fund our public system. The appropriation-in-aid part of the budget is €460.2 million. Will the Minister of State let me know what this funding consists of and where it comes from?