Denis Naughten (Roscommon-South Leitrim, Independent) | Oireachtas source

The final point that I wish to make in respect of this legislation concerns an issue which is fundamental to universal health care, namely, capacity. The capacity is not in the system to provide free GP care for the population as a whole. When we were working on this initiative prior to the 2007 general election, one of the key fundamental elements to ensuring the FairCare universal health insurance worked was that capacity needed to be built up within the system before rolling out enhanced accessibility. If that was not done, demand would be built up for services which did not exist. It is all well and good to provide people with free access to GP care, but, as we know, there are huge delays and backlogs in getting occupational therapy, physiotherapy, and all of those other therapies. This is not only in respect of adults and older people but also in respect of children. Giving children or older people free access to a GP without putting the physiotherapy, occupational therapy and speech and language therapy capacity in place is a pointless exercise.

When we look to the United Kingdom, we see an appalling situation where primary care is creaking and bursting at the seams. A study was completed last year which showed that GPs in the United Kingdom are under considerable strain, with insufficient capacity to meet the current and expected needs of parents. The interesting and telling thing is that the number of patients waiting up to four weeks, one month, for a consultation will increase significantly if capacity is not provided in the system. If we do not resource primary care properly, we will see waiting lists for GPs in this country. It will force people to go down the SwiftCare and Beacon accident and emergency route. People will have to buy in specialist GP cover because the public system will be creaking. It is fundamentally important that we put the proper resources into primary care. This is not only in order that GPs will be able to deal with the capacity issues, it will also bring a far more significant return in reducing demand in accident and emergency departments and acute hospitals. There will also be a knock-on impact in delayed discharges and nursing home supports.

We need to treat people before they need to go to a hospital. We need to try to reduce the number of people who are getting sick by putting resources for preventive measures into communities. We need to ensure that when people get sick, they can access a GP or other primary care physician or specialist.

Only those who are really sick should attend hospital. When they do, they should be treated and discharged into the community as quickly as possible. The system of housing adaptation grants which have been slashed significantly in recent years should not block people from being discharged from hospital. In the past two years in my county the grant has been cut by 72%, which has had a direct impact on the number of delayed discharges. This is replicated across the country.

There needs to be fundamental change in the health system. We must front-load it and resource preventive care services. If we can do so, we will reduce demand in hospitals and overcrowding in accident and emergency units and have a much better service for everyone.

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