Martin Daly (Roscommon-Galway, Fianna Fail)

I wish to follow on from Deputy Ardagh because I was very impressed by her passion on the subject of CAMHS. What she said is true. While I take Mr. Gloster's observance that he does not feel he is in a position to second guess a clinician’s decision, any branch of medicine or the health services is open to review. We had a situation in the Roscommon and east Galway area where it was my impression that the professional receiving the referrals – this is not historical but, rather, recent - almost viewed it as some sort of performance to push back as many referrals to GPs.

It was a major issue for GPs in the area, so much so that letters were full of disrespect for fellow professionals. I think it has been resolved now, but the same issue keeps coming up over and over again. Deputy Ardagh is speaking about Dublin. I am speaking about rural Roscommon and east Galway.

At the end of the line, parents are dealing with very difficult situations and are striving to do their best for their children. I will give an example. I had a family, who, for work reasons, worked in middle management. They went to the west coast of America on a contract for two years with a child with ADHD. The child was assessed over there by a professional psychologist and paediatrician specialising in the area and put on treatment. The child came back to this country because the contract was up. The parents wanted to continue the medication because it had changed their lives in terms of the child's ability to attend school. My referral to CAMHS was received and sent back. Essentially, it stated that it did not think the child was suitable for its assessment. Second, even if the child was seen, the child would have to be taken off the medication, reassessed at six months and then it would be decided because the assessor could not be guided by professionals in the United States of America. I had reports from them.

That is the level of dysfunction. That is not patient-centred, parent-centred or child-centred. It is not productive in any way. It creates resentment, anger and frustration. I heard this from loads of GPs in that area who are outraged not just because of the waste of time for them, but also because of the disservice to the families and the parents who are trying to do their best and making their lives even more difficult than they already are. What Deputy Ardagh says is true.

I am delighted with Mr. Gloster's assurance of this one-door policy of a referral into the service where a child in the family will receive a service which is deemed most appropriate by the HSE. I am happy with that and with the assurance on that. What Deputy Ardagh described is true. It is not just her experience or that of a few people in her area; it is true. It seems to be an institutional issue throughout the country because GPs in other parts of the country are telling the same stories about the same service. I accept Mr. Gloster's assurances on that and that things will change.

Moving on, Senator Boyle spoke about GP numbers in rural areas. It may be an easier topic to discuss. Nonetheless, it is a service that is required. I agree with Mr. Gloster that the modelling has to change. Part of that is a reluctance. It is not just in general practice; I see in specialties in smaller hospitals that reluctance and a difficulty to recruit and retain medical professionals and allied health professionals in those areas. I accept that there has been an extension of training. We also need to be careful when we cast a net so wide that we make sure that we get high-quality graduates into those training programmes. That is also a challenge.

In some remote and rural areas and deprived inner-city areas where there is specific need and a difficulty recruiting and retaining GPs, we need to look at a different model. Somewhere along the line, someone decided that 1,200 medical cards were enough work for one GP in 1989, with one nurse and one secretary. No one ever did a working time study on it. We have changed considerably in the last 35 years to a point where there is much more complexity in the work we do. The consultations are longer. In those areas, the State does have a responsibility to provide a service. It may be that there are fewer patients but it takes two GPs to provide that service, maybe on a salaried model or some other subsistence model. We need to think outside the box. That is not just in rural areas; it is also in deprived inner-city areas. What is Mr. Gloster's own observation on that?