Mary Lou McDonald (Dublin Central, Sinn Fein)

It is known that countries with comprehensive primary care systems tend to have lower health care costs, lower mortality rates, longer life expectancy rates and greater satisfaction rates in their health care systems. As long ago as 2001, Deputy Martin of Fianna Fáil, then Minister for Health, announced with great fanfare his Government's primary care strategy, A New Direction. The outcomes, of course, have fallen far short of the promises made by him. While time has passed, the fundamental flaw of Fianna Fáil's strategy lives on in the Government's plans for primary health care provision.

Primary care teams need facilities, but, to date, sufficient buildings have not been provided to complement the Government's primary care strategy. Instead, the few virtual primary care teams available have no buildings from which to deliver services and are unable to develop robust relationships with their communities or one another. Despite this recognised failing of Fianna Fáil's health strategy, the programme for Government does little to right this wrong. Although experience shows that primary health programmes work best when appropriate infrastructure is in place, primary health care centres get a mere passing mention in the Government's post-election commitments.

This problem is compounded by the ongoing shortage of general practitioners. Dublin's north inner city, which I am proud to represent, has the lowest general practitioner coverage per head of population and the highest incidence of closed GP lists. It also has some of the worst health and deprivation indices in the country, with the poorest access to primary health services. While the north Dublin inner city training programme in general practice is trying to address these imbalances, the lack of primary care facilities continues to thwart the efforts of those concerned. It is time the Government stepped up and delivered desperately needed primary care facilities to the inner city, as well as increased GP training places. The evidence shows that the establishment of general practitioner training programmes in places in which it has been traditionally difficult to attract GPs leads to an increase in the number of GPs working in these areas and this is what must happen. These are not options or luxuries but basic must-haves.

I take the opportunity to note the news that an independent review group has recommended the Mater hospital site as the best location for the new children's hospital. I support the call of my colleague, Deputy Ó Caoláin, for the publication of that review, as well as the concerns he has raised as to what will happen in the interim to Temple Street, Crumlin and Tallaght hospitals. These hospitals must be properly resourced and supported to continue to provide excellent hospital services for children, while awaiting the opening of the promised new facility. Moreover, now that a decision has finally been made on the location of the children's hospital, action is needed.

The Government must also address the ongoing shortfalls in existing hospitals, including the large acute hospitals in Dublin. I note the HSE recently gave the Mater hospital a red card for unsatisfactory performance in respect of waiting lists for patient admissions. I am conscious this problem is not unique to the Mater hospital, as the numbers languishing on hospital trolleys across the State testify. Moreover, an estimated 200,000 citizens are waiting for outpatient appointments in hospitals across the State. This is simply stunning and a shameful figure for any Government to stand over. As Members debate this issue, what the Minister intends to do about it is anyone's guess. The Sinn Féin motion calls on the Government to maintain services and provide access to quality services on a universal basis. I commend it to all Members of the House.

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