Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I join with other Members in welcoming the Health (General Practitioner Service) Bill 2018. It is a small but important measure in recognising the exceptional work that carers do. Many Members have referred to the outstanding work done right around the country by people caring for their children, elderly parents, partners and other people. It is done in a manner that is first and foremost about love for the person for whom they are caring and we see so many people devoting, in many cases, their entire lives to this role. They take it on willingly but there must be a recognition that in doing so, family members taking on the caring role are not only doing an extraordinary job for the people for whom they are caring - their loved ones - but they are also doing an extraordinary job in the saving they help to make for the State.

If a person requires full-time care and attention and has to go into a nursing home or other kind of facility, the cost is extraordinarily high. That always has to be the yardstick by which investment in carers is measured. The truth is we do not do half enough to recognise the work carers do because it is exceptional and very generous of them. It is done with an open heart but it needs to be recognised properly and we need to go much further than this Bill.

There is a need to ensure that training is provided for people in full-time caring roles. It is a specialised job to care for somebody who is immobile, such as an elderly person or a person who needs much lifting and handling. Carers very often do themselves serious injury by trying to cope with a situation like that and we could be doing much more in providing training in patient handling for people who are caring. We could also do much more to make aids and appliances, things like hoists and housing adaptations, easier to access. Funding for those services, aids and appliances is limited and very often, people must go on long waiting lists to avail of them. I hope in the run up to the budget that the Minister of State will make a strong case for increasing the funding for aids and appliances. I refer to items like ramps, grab rails and so on, as well as the need for walk-in showers and downstairs bathroom facilities etc.

That applies to people in private housing. When it comes to people in social housing, the lists are much longer and it is much harder to access those aids and appliances. There is a need to look at this again. I, and I am sure many other Members, have come across cases where a person, generally an elderly person or a person with a disability, is prevented from coming home from hospital and being cared for at home simply because there is inadequate funding for those kinds of grant schemes. For want of a ramp, rails or downstairs bathroom facilities, people often have to stay in a hospital bed, which costs about €1,000 a night. If a small amount of money is provided to make the house more accessible, that person could come home and be cared for there. Joined-up thinking is needed between local authorities and the HSE. That is not going on at the moment and there is a real disconnect.

On the granting of carer's allowance, there has to be a relaxation in the application of the habitual residency rules. This is a major problem now, as Irish people are living longer and many people can expect to live into their 80s and 90s. That is fantastic but the reality is that not everybody can live into their 80s and 90s and be fully mobile, healthy and free from debilitating illnesses. On a fairly regular basis, we see cases where the son or daughter of a man or a woman has emigrated to the United States, the UK or wherever. That elderly parent is becoming less mobile and wants to stay in his or her own home but needs to have somebody looking after him or her. When the son or daughter comes home to look after the elderly parent, he or she is refused social welfare support because of the habitual residency rules. They are applied very tightly and very strictly and that needs to be looked at.

The other thing on which we need clarification is the point raised by Deputy Broughan. We need the Minister of State to clarify that this provision of GP visit cards will apply to people in receipt of the half-rate of carer's allowance. It is not clear from the legislation. It also will be important to ensure that adequate funding is provided for the Carers Association. It is an extremely difficult job caring full-time for a person who is infirm, elderly or with a disability. People need regular breaks, regular support and psychological and moral support. That often comes from the local Carers Association, which can meet with people that might organise sessions where carers can come together and share their concerns, as well as get advice and a break etc. That can only happen adequately if the Carers Association is funded properly. We need to make sure that we are caring for our carers.

Very often they are left to care in isolation without the kind of supports necessary to enable them to continue to do their important work.

While I welcome improved access for carers in terms of access to free GP services and the extension of that facility to under sixes that has taken place in recent years, and indeed the additional work that will come to GPs as a result of the repeal of the eighth amendment, I note that GPs are expected to do a lot of extra work. At the same time recruitment and retention of GPs is becoming increasingly difficult and for primary care staff generally, including public health nurses, therapists, speech and language therapists and so on. The provision of adequate health services at community level is now a huge challenge. The aim is full implementation of Sláintecare, which not only proposes a universal single tier health service with much greater access to health care, but also a new model of care, where we would move away from the hospital-centric model of care we have at the moment towards the provision of more and more services in the community. This is particularly the case when it comes to the management of chronic illness, which accounts for 70% to 80% of healthcare activity. Conditions such as asthma, diabetes and COPD should be managed locally in the primary care setting. They can be managed much better there. We get better health outcomes and much better value for money if we provide services in the primary care setting rather than in the expensive acute hospital sector. That can only be done if we have capacity at primary care level.

Many GPs are opting to go abroad to work in systems that are functioning better than ours, where they are treated better and where there is certainty about the future of the service. The financial emergency measures in the public interest, FEMPI, cuts, which took place a number of years ago and which amounted to 38% of the income and practice supports of GPs, have never been reversed, unlike the cuts endured by every other public sector worker. Those cuts have been reversed, or at least those affected are on a path to reversal. That has not happened for GPs. The cuts they faced have not been reversed at all and we are paying a price for that in terms of the loss of GPs. Of course, it is also the case that GPs want to work within multidisciplinary teams and in premises provided by the State. Unless the Government addresses these issues and faces up to the crisis in general practice we are now facing much of this talk will be academic. Carers or other people will not be able to get access to GP services. That is the real challenge ahead and it is a challenge the Government is currently ignoring.

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