James Reilly (Dublin North, Fine Gael) | Oireachtas source

Early in 2012 the HSE embarked on a prioritisation exercise for primary care, PC, centres across the country. It is the intention of the Government to develop as many centres as possible by one of three separate methods: direct investment; by way of leasing arrangements; or by way of public private partnership. The locations were then considered for development by way of PPP as part of the Government's stimulus package. Selecting the primary care centres under PPP was not - as is generally believed - done on the basis of one criterion, the deprivation index. Three criteria were deployed: the deprivation index for the catchment population of the centre; the service priority identified by each integrated service area-local health office; and an accommodation assessment which assessed accommodation available for the primary care team within the catchment area, the quality of the accommodation, and whether it was spread over more than one building.

The HSE in this new process identified 338 locations for PC centres. From this, 20 were selected on the basis of accommodation availability in the locale, service priorities, and deprivation. A total of 37 locations within the list of 338 had a similar ranking. I accepted the first list of 20 prospective centres presented by the then Minister of State, Deputy Shortall. However, I decided - in consultation with my Department officials and ministerial colleagues - to go beyond the initial mathematical model on the basis that the number was too small and that we needed at least 35 centres. Advice from the HSE and the Department of Health based on experience of PPPs is that if only 20 were pursued considerable slippage could arise and the health system could lose a badly needed investment. I also took into the account that the track record of the HSE in delivering PCs on time is poor. In addition, the available €115 million stimulus fund could only be accessed by means of PPP.

As I wrote to the then Minister of State, Deputy Shortall, on the 25 July, "A very strong consensus emerged at Government level that identifying 35 locations would stimulate and encourage wider interest and participation...". In other words, if we were to identify only 20, and stick with 20, GPs would then be able to sit back, await their completion and then enter on their terms only. If one looks at what happened in an urban area where a primary care centre was built, the process began four years ago with pre-contract discussions with local GPs, the building was completed in 2012, but it took several months to get the GPs to move in. A similar situation arose in a rural area. Therefore, the list was widened. In addition, new criteria were added. It was evident, for example, that consideration needed to be given to existing health facilities; GP to population ratio; pressures on services, particularly acute services; funding options, including Exchequer-funded, HSE build or lease; and the implementability of a PPP in terms of size, site and scale.

The criterion of existing health facilities was added because if they were not considered one could possibly have a health centre built in the shadow of an acute hospital, while a nearby area of great need would be left without a primary care centre, which would make little sense.

Under these wider criteria, 15 additions were made to the list, some of which had been identified as high priority by the HSE as far back as 2007, under a Fianna Fáil Government. However, because of the weighting I mentioned - namely, the multiplication of the deprivation index by three - two of the areas that had been identified in 2007, Balbriggan and Swords, lost out and were swept from high priority to low priority. Under the original priority system both would have been in the top 35 but under the new system, with an altered weighting system, they ended down the list. The realities had not changed but the weighting made it look as if they had.

Balbriggan is an area of high unemployment, with no existing primary care centre, whose current health centre is in a very poor state. It will proceed under a lease arrangement. Swords has a population of 48,000, no primary care centre and no direct public transport link to its nearest hospital, Beaumont Hospital. There can be no doubt that these two areas are high priority for primary care centres. It is my intention to further primary care developments as resources become available.

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