Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I compliment all the members of the committee. I was not on the committee, but it is an honour to have an opportunity to speak this evening. Deputy Shortall did a phenomenal job in pulling all of these different personalities together for the past 11 months, starting with four hours twice a week and moving up to 12 hours a week. I thank my colleagues, Deputies Kelleher, Brown and Brassil because it was a huge commitment. Members from all parties and none made this commitment for the past 11 months in the best interests of all the people whom we in these Houses represent and I thank them all very much.

I will continue in the same vein as Deputy Crowe. As Deputy McGuinness said earlier, there is a great opportunity here and the report provides the foundations and building blocks for the future. Everybody has contributed to it and everybody has hit on every aspect that comes through their own doors, be it personal or from constituents. There are certain wins for the Government in the report. We spoke about dental care and I looked at the costing. In the first year it would cost €17 million. However, it is off the pitch and we have moved on. The Government would show that it is really committed by hearing what is being said. Actions speak louder than words and this is what we are looking for. Regardless of whether we leave politics out of it, actions speak at the end of the day and this is how we know the Government is taking it very seriously.

The report is aspirational because what it recommends would be very expensive. When Deputy Shortall spoke, I thought she was costing us €1 billion a minute but, to be quite honest, it is a pathway to the future and the recovery of the health boards. I had an experience during the week, which I will share with the House later. We need to bring accountability and traceability into it. We need to remove certain layers of bureaucracy from the health service and bring it back to change managers, who have to be business managers. They have to be able to walk in and state what resources are there, what actions are being taken and what is being delivered, because it is the only way this will be done.

During the week, I was fortunate enough to get my hands on an intensive home care package. Such packages are like hen's teeth. It is the first time there has been one in Portumna, Woodford, Killimor, Mullagh or Eyrecourt, all of which comprise a large area in east Galway. The intensive home care package is for a person with dementia, and it means that person will leave hospital care with exactly what it says on the tin. The doctors had stated that on his release the gentleman would need 28 hours home care. Previous to this, he had been receiving ten hours. He was told the 28 hours could not be obtained because of the waiting list for intensive home care packages. I compliment Senator Colette Kelleher and Deputy Butler on their assistance. They helped me put the case together and they worked with the family. The person has obtained the 28 hours, and will receive speech and language therapy and nursing care hours. For his family members it means their father, who is in his early 60s, has been returned to his home. This is the wraparound service we speak about. I am sharing a success story because sometimes we speak about all the negativity in the health service. This is a situation which has worked very well.

This home care package is one of the 500 such packages but, to date, fewer than 300 have been allocated. Last year, we did not spend enough on them because only 110 of the number actually allocated were drawn down. We need to use what is allocated. Last year, 500 packages were allocated and 500 should have been used. There is a commitment to 500 this year and they need to be used. Dementia is a growing problem in the State. In 20 years' time, we will have 110,000 people with dementia. If we do not start building on home care packages year on year, which is recommended in the report, we will not address the problem. This is just one aspect.

I come from a rural community in east Galway and the most important things for me, as is the case for all communities, are primary care and GPs. GPs deliver 25 million hours a year in services and consultations. They are a breed that will die unless we do something to support them. We are exporting our GPs abroad. The GP contract is a fundamental part of what needs to be addressed in the report. We need to encourage more GPs into the service. Gone are the days when a GP would work 24 hours a day seven days a week, morning, noon and night. That service is not there any longer. GPs want a work-life balance and well-being for themselves and their families. They want the GP contract reviewed. When the GP contract is being reviewed we need to look at putting in place primary care centres in tandem. If we do not have primary care centres dotted throughout the entire country, our acute hospitals will be in crisis.

We need to start with where a problem originates. The report would deliver all of that to which I refer because it looks at every aspect, including where it starts, which is in the community. It starts with a person's first visit to the GP. We could halt it straight away by building up and providing the required wraparound service to communities. We can put in place wellness centres and diagnostics in our GP practices. We can then bring the role of pharmacies into communities. This is what we need to look at and this is the value of the report. It is a fantastic pathway and mapping system but, with no disrespect to anybody, it does not contain anything of which we were not previously aware. We have articulated - in a huge document - the requirements of what is needed but we have also shown examples of where we can have quick wins. We can also see what is needed when we look at communities and the geography of areas. In my community and, I am sure, in many others, it is GPs and primary care services that are needed.

Earlier, we spoke about mental health and CAMHS. At present, 5,200 children in Ireland are waiting for access to social care workers. That is unforgivable. Of those 5,200 children, 1,520 are level 3 and level 4. Level 3 and level 4 children are classed as being at risk. A child at level 4 will be monitored because he or she will have suicidal tendencies. This is where early intervention is needed and we need to recruit the requisite staff at a rate of knots. If we cannot recruit through the public sector, we need to look at what other services are out there. We need to look at organisations such as Sugru, a not-for-profit group which provides these services. It can provide counselling and a wraparound service to a family and a child. This is what we need to look at. It is not just about the individual as we also need to look at what support we can give to families. With regard to the 1,520 children at level 3 and level 4, we must consider advocacy groups such as EPIC and YAP, which have social workers. These are advocate groups that have social workers who can provide the service. The committee's report tells us what we need but it also tells us that we can look outside the box and start linking matters. Until such time as we start to join the dots, the system will not work.

I conclude by saying well done and thanking the committee for the opportunity. The report will be a talking point for years to come. However, I do not wish to see it remain on a shelf as happened with A Vision for Change. A Vision for Change was a fantastic document if it had been implemented. Regrettably, it never reached implementation stage. We picked parts from it. The Government must set a monitoring gauge as to what it will do on this report on an annual basis. It should clearly state to everybody, "we have taken this from the report and over the ten years your vision should be delivered".

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