Róisín Shortall (Dublin North West, Labour)

I thank all the Members who contributed to this useful debate, with many important issues raised. We all share an interest and concern in the health service, which is one of the most fundamental services in terms of the impact on our constituents.

The Government is committed to introducing a better and more efficient health system, which will have improved services for the people of this country. With this in mind, we are committed to introducing a single-tier health service that will deliver equal access to care based on need, not income, albeit at a time when extremely challenging economic and fiscal conditions prevail. The Minister for Health, Deputy Reilly, has already outlined to the House the financial challenge facing the health sector and the difficulties anticipated owing to impending staff retirements. He has also described the various actions and reforms being taken across the broader health system to mitigate the effects of budget and staff reductions on front-line services and to ensure that there will not be a straight-line reduction in services.

I wish to outline for the House the detailed reforms proposed within the primary care area. As recently announced by the Minister, Deputy Reilly, new administrative structures will be put in place within the HSE to reflect the need for greater operational management focus on the delivery of key services and greater transparency in funding, service delivery and accountability. These are essential if we are to provide a responsive health service.

This will involve appointing a number of directors at national level, one of whom will have responsibility for primary care. We are all agreed that 90% to 95% of a person's health needs should be catered for in primary care and yet it is the poor relation of the health service and incredibly there is no national director with his of his own budget for primary care. The director of primary care, who will be appointed shortly, will be tasked with establishing clearer service delivery structures and clear funding arrangements.

It is important at any time, but particularly in these challenging times, that money is spent wisely and services are delivered in the most cost effective way. The HSE's national service plan for 2012 includes a challenging cost saving target of €124 million in the area of drug costs. Legislation will be introduced this year to provide for a system of reference pricing and generic substitution for drugs prescribed under the GMS and community drugs schemes. These measures will reduce costs for both the HSE and patients. Discussions with pharmaceutical manufacturers are also under way to ensure these savings will be achieved.

It is clear that reform is needed and the development of primary care services is an essential component of the health service reform process. In a developed primary care system, up to 95% of people's day-to-day health and social care needs can be met in the primary care setting, which is what we want to do. Primary care teams are being developed. Even though we are talking about a 2001 primary care strategy, progress on delivering that strategy during times of plenty in this country was pathetically slow and we are paying a serious price for that now. If we can make progress at this late stage in developing the primary care teams, they will give people direct access to integrated multidisciplinary teams of GPs, nurses, physiotherapists, occupational therapists, public health nurses and all other critical health-care personnel required to provide that multidisciplinary care. Additional services such as speech and language therapy should also be provided on a sessional basis.

Each primary care team will serve a defined population. There are currently 425 primary care teams in place, but they are not all fully developed yet. It is regrettable that progress on this matter in the past decade has been so terribly slow. The HSE's service plan commits to having 489 operational teams in place by the end of this year and I, as Minister of State with responsibility for primary care, will be in constant discussion with the HSE to ensure we have fully operational teams by the end of the year.

Each primary care team will be supported by a wider range of professionals, including pharmacists, dieticians, psychologists and chiropodists, who will form a health and social care network. Each network will support approximately three to six primary care teams. The vast majority of specialist-based services will be organised at this level, including mental health community teams, child protection etc. Primary care teams will also create an environment which enables structured approaches to chronic disease management, enhanced multidisciplinary team working, improved diagnostic capabilities in primary care, and the integration of services between primary and secondary care.

The service plan states the HSE intends to commence a national roll-out of chronic disease management for diabetes during 2012. I am very glad that €2 million has been provided in the current service plan for this very important new development in our health service. The HSE will also progress preparations for the roll-out of similar initiatives for other chronic diseases, including stroke, asthma and heart failure. The delivery of these chronic disease management programmes at community level is key to moving to a new, much more responsive and cost effective model of care in the health service. The provision of integrated services whereby the patient has access to an extensive range of services in their own community, ideally all in the same building, is undoubtedly the way forward and this will help to reduce considerably the reliance on hospital-based services.

The service plan also demonstrates the continued success of the general practitioner out-of-hours service. In addition, a key commitment in the programme for Government and a fundamental element in the health reform process involves significant strengthening of primary care services to deliver universal primary care with the removal of cost as a barrier to access for patients. This commitment will be achieved on a phased basis. As it stands, the system cannot deal with the demands that will come in future. Therefore, we must gear up on a phased basis to ensure we have the additional GPs, nurses and other professionals to provide universal access to free GP care. The introduction of this programme will begin this year with the first phase in which all those currently claiming under the long-term illness scheme will come under the free GP care initiative. Legislation is being developed in this regard at the moment and we hope to have it in place by mid-year.

Funding of €20 million has been provided to fill as many vacancies as possible arising from retirements in the HSE within the primary care area. There is no doubt these retirements will pose significant challenges for us in terms of continuing to provide an acceptable level of care. However, within the primary care area a figure of €20 million is ring-fenced to back-fill as many of these places as possible. Naturally, we will be unable to fill all these vacancies but we will fill as many as possible and we will concentrate the resources on front-line resources. There is also the prospect of an additional €5 million being available if we can make additional savings in the drugs area.

The Department has also commissioned a study to examine the question of workforce planning in primary care in order that we can be assured that there will be a sufficient number of GPs and practice nurses to cater for the demand that will arise as we roll out free GP care. The provision of GP care without fees during this Government's term of office is an absolute priority for me. The implementation of this commitment will be delivered upon beginning this year. We hope to continue this development during the coming four years in order that we get to a point where the whole population will be covered by the initiative.

The strengthening of primary care planned in the programme for Government reflects the need to move to new models of care throughout all service areas that will treat patients at the lowest level of complexity in their community and provide quality services at the least possible cost. This approach makes sense from the patient's point of view, from a health point of view and from a cost point of view. We are determined to deliver on this as soon as possible and work is well underway on these commitments as we speak.

I refer to the issue of medical cards and the difficulties that have arisen in recent times. I realise this is a matter of concern to many Members. There is no question but that the level of service provided to patients has been unacceptable. There are several reasons why this has been the case and the issue has come to a head in recent months. There was a changeover from the system of community welfare officers, CWOs, processing medical card renewals and applications. A considerable backlog was passed over to the HSE primary care reimbursement service, PCRS, to deal with, to the point where at one stage those involved were overwhelmed by the sheer numbers involved. There was also an issue in terms of their gearing up for the centralisation. I took the view that they undertook this too quickly and I expressed that view at the time. In addition, there were difficulties with the processing systems. I was not satisfied with the type of service being provided or the systems in place in the PCRS in Finglas. Progress has been made in recent weeks and I intend to circulate all Members with the details.

From this month we will have moved to a situation whereby there will be self-assessment for the renewal of medical cards and this will assist the process greatly. This will be matched by a spot-checking system to ensure there is proper accountability. I assure Members that anyone whose medical card has come up for renewal and who has engaged with the HSE in a meaningful way will not lose an entitlement until a final decision is made on that entitlement. Members can put at rest constituents' minds in this regard. The backlog is being worked through the system and we are moving towards the new self-assessment system. I hope to see significant improvements in the coming weeks in this regard and I will inform Members of the details of the new system without delay.

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