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

I will echo the points made by previous speakers. There was not much consideration given to other Members in providing the detail of this deal. The relevant information should have been provided some time ago, and long before this debate.

That was quite disrespectful to Members on this side of the House.

It is 18 years since the primary care strategy was launched. In that time, no Government or Minister for Health has been serious about the primary care strategy. Mere lip service has been paid to it, which is quite incredible when one thinks about the primary care strategy of 2001 and several subsequent related strategies culminating in the Sláintecare report. The reorientation of the health service away from expensive acute hospital care to community, primary and social care is not rocket science but, rather, very basic logic about the right way to run a health service. It makes absolute sense to have early intervention regarding medical conditions and for services to be provided locally at the lowest level of complexity and close to where the patient lives. That is the way to get the best health outcomes and, of course, the best value for money. However, for some unknown reason, no Minister has given effect to the aspirations in the primary care strategy. That may have been due to a lack of courage on the part of the many Ministers over the past 18 years because most of the vested interests are located in secondary care. There are some very strong vested interests in that area. We know that the hospital sector has always taken the lion's share of health funding and, for that reason, we have a very skewed, inefficient and ineffective health system. Regrettably, no Minister was prepared to reorientate the health service to where it ought to be and tell the hospital sector and the various vested interests that this was not the right way to run a health service and that we were going to emphasise and prioritise primary care. Unfortunately, that has not yet happened. I very much welcome the fact that the Sláintecare report is so strong on the need to reorientate the health service. There is a clear blueprint for doing so and, as such, there is no excuse for the Minister or any of his successors not to act in that regard. It makes absolute sense to so do.

My concern is that there is a 47 year old contract which has not been fit for purpose for some time. Even after this deal, it will remain unfit for purpose. There is no doubt that the deal contains improvements, but it is not a new contract. We cannot run a modern health service on a contract that is almost 50 years old. Although several elements of the deal are to be welcomed, the reality is that an entirely new contract was needed was. I very much regret that after all of the promises and early days talks and so on, the Government came up with a deal which only tinkers with the original contract. There is an acceptance of that fact on the part of the Minister, who stated that there is a need for a longer-term strategic review of how general practice should operate within the health service and that the Department will lead a strategic review of general practice with a view to developing a new contractual framework. There has been 47 years in which to do that. Why is that at this stage, after all the protracted talks, the Government is only now recognising the need for a strategic review? God knows when we will see an outcome from such a review. It is very disappointing that there is no new GP contract, which is what is needed.

That said, I hope that the Minister moves quickly and that this is not the end of what he will deliver in regard to contractual arrangements with GPs but, rather, is only the start. I hope that he is serious about the strategic review and that it will get under way very quickly. I remind the Minister that the Committee on the Future of Healthcare, which examined this whole area in significant detail over a long period, wrote to him and outlined several key areas that needed to be included in a new contract. These issues arose time and again in the course of the Sláintecare process. Key things that are currently missing are the issue of access to diagnostics, the need for an ongoing review of the contract - we should not have such a long contract period - and the need for salaried and part-time GPs.

The agreement goes some way towards restoring the savage FEMPI cuts. The individual measures regarding chronic disease management are to be welcomed, as is the €2 million set aside for GPs working in areas of disadvantage in particular. Deep End Ireland is doing an extraordinary job in that regard. However, far more needs to be done. We can achieve far more through our health service if the Minister takes the lead on this issue and takes bold steps in respect of the much-needed reorientation of the health service away from hospitals and towards primary and community care.

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