Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I am pleased to be here this evening to update the House on a range of important developments in the area of primary care. As many Deputies will be aware, the reality is that our primary and community care system, as currently configured, is ill-equipped to play the role we all know it should play, and must play, if we are to respond to the healthcare challenges of the 21st century.

Our population is not only growing but is becoming older, and we face a growing prevalence of chronic disease. Our current hospital-centric model of care, which has its roots in responding to accidents and episodic diseases, simply cannot respond efficiently and effectively to meet the health needs of our population.

It is for this reason the expansion of community and primary care is at the heart of the Sláintecare vision, and it is important to recognise the progress that has been made in delivering on that vision. The provision of modern, well equipped and accessible infrastructure is essential if we are change our model of care which is why we have prioritised investment in primary care centres. There are now 127 operational primary care centres across the country, up from just 70 at the end of 2012, which represents an increase of some 80% over a six year period. A further three centres are currently being equipped and will open shortly, while another 16 are under construction. Just as importantly, there is a pipeline of more than 60 projects at the advanced or early planning stages. Furthermore, at the beginning of May, the HSE placed an advertisement in the national press seeking expressions of interest from developers with a view to progressing a further 47 centres.

As well as enabling the delivery of services in high quality modern facilities, primary care centres support the delivery of integrated care by facilitating closer co-ordination and co-operation between health professionals from across different disciplines. They also provide a single point of access to services for the individual and can serve as a resource more broadly for the community, creating a focal point for local health initiatives or providing community groups with a place to meet. The delivery of additional primary care centres in the years ahead will support other initiatives as part of the Sláintecare plan to ensure more healthcare services will be available in our communities.

In tandem with the delivery of primary care infrastructure, there has been a continuing programme of investment in the sector to build capacity. The HSE’s national service plan for this year allocates €897.2 million to primary care. This headline figure reflects several important funding initiatives that have been introduced since 2016, including the following: ring-fenced funding of €4 million to facilitate the recruitment of 83 posts in speech and language services; dedicated funding of €5 million to recruit 114 assistant psychologists and 20 staff grade psychologists to provide early intervention mental health services for those aged under 18; and provision of a €25 million primary care development fund to enable a range of initiatives to be progressed.

Primary care was prioritised in this year's budget, with an additional €50 million provided to boost capacity in the sector, which is an increase of 6.1% on 2018. This will allow the recruitment of additional therapy staff and nurses, alongside further service development. As well as supporting therapy services, the investment has allowed us to develop such services as paediatric home care packages to allow children with complex needs to be cared for at home while enabling the expansion of community intervention teams, CITs, which prevent unnecessary hospital admission or attendance. CITs are a prime example of how an expanded primary care setting can help ease the pressure on acute hospitals, with an estimated 11,307 bed days saved in the first four months of this year alone. We are also working to develop our diagnostic services in the community. This will be an important achievement if we get it right. In 2019, 67,000 ultrasound tests and 79,500 X-rays will be delivered via direct GP access to radiology services.

This investment in primary care infrastructure and services in recent years provides a solid foundation for developing a much more comprehensive community and primary care system. We intend to build on this foundation with the development of community healthcare networks. Under the network model, one identifiable and accountable network manager will be responsible for the delivery of primary care services to a local population of approximately 50,000 people. Primary care will be positioned at the heart of service delivery and emphasis will be placed on ensuring effective integration of other specialised services such as social care, mental health and access to hospital. The network model will be central to the development of improved primary and community services. Implementation will begin this year with the establishment of nine learning sites.

April was a significant month in clearly signalling that we are serious about radically changing how the health system works. The month saw three important achievements, namely, securing agreement on GP contractual reform, publishing the national oral health policy and introducing a series of measures to enable more people to access affordable healthcare. The development of a new, modernised contract for the provision of general practitioner services was always going to be a significant element in facilitating a move to primary-care-centred health services. The agreement reached with the Irish Medical Organisation, IMO, has the potential to be a landmark moment for health reform and I was delighted to see it win the support of 95% of members of the IMO in a recent ballot. For the first time, we will see the delivery in a primary care setting of structured care on a large scale for patients with chronic conditions. More than 400,000 medical card and GP visit card patients with chronic illnesses such as diabetes, asthma, chronic obstructive pulmonary disease and heart disease will benefit from new and improved chronic disease management. In addition, the agreement paves the way for a wide-ranging set of modernisation measures in the areas of e-health, medicines management and multidisciplinary working.

For its part, the Government has committed to increasing investment in general practice by €210 million, or approximately 40%, over the next four years. This will mean significant increases in capitation fees for GPs who participate in the reform programme, as well as the introduction of new fees and subsidies for additional services. There will also be increased support for rural practices and for those in disadvantaged urban areas. For the first time, there will be a ring-fenced fund for general practice in urban areas, an important development that arises directly from the work of the Sláintecare committee. In short, the agreement will allow GPs to care for their patients both in the way they want to and in the way we need them to. It will help to stabilise general practice after some difficult years.

Smile agus Sláinte, the new national oral health policy, was also published in April. It provides a framework for the dental service to evolve from a diagnose-and-treat model to a locally available, person-centred, proactive and preventative approach. Under the policy, all children up to 16 years of age will receive eight oral healthcare packages, including examinations, assessments, advice, prevention interventions, emergency care and referrals as appropriate. Oral healthcare packages will also be provided for medical card holders over 16 years of age. The packages will be provided in a primary care setting by oral healthcare practitioners contracted by the HSE. Smile agus Sláinte provides the groundwork to transform oral health services. It embraces the same ideals as Sláintecare, with the needs of people at the core and the provision of services in the local community paramount.

The third development delivered in April was the introduction of a series of measures to enable more people to access affordable healthcare, which is also generally in line with the recommendations of Sláintecare. First announced as part of budget 2019, the measures included a 10% increase in all GP visit card weekly income thresholds, the benefit of which we have seen through the several thousand additional people accessing free GP care as a result. There were also reductions in the monthly drugs payment scheme threshold and a reduction in prescription charges for all medical card holders over the age of 70, making it cheaper for people to make a trip to their pharmacy, whether they are on the drugs payment scheme or paying prescription charges. With a focus on ensuring and supporting care in the community, the measures extend free healthcare to more people and reduce the cost for others. The Government is committed to widening access to primary health services, which is reflected by our intention to engage with the IMO on the proposal to extend GP care without fees to children aged between six and 12 on a phased basis, something for which I look forward to legislating this year. I also look forward to sitting down with pharmacists' representative organisation, the Irish Pharmaceutical Union, IPU, this year to negotiate a new pharmacist contract. I addressed the IPU conference in Galway in recent weeks. Deputy Brassil raises this issue with me often. We will sit down with pharmacists to examine how they can play a greater role in the provision of healthcare, as is their wish, and how the Government can invest in the pharmacy network.

It is clear that we are investing in and developing primary and community care. There has been momentum in that regard this year, as I have outlined. The momentum needs to gather pace, however, as it will do in the months and years ahead. We all know there are many grand plans now sitting on shelves and gathering dust but this time will be different, not least because of the unified focus of the House on realising Sláintecare and the structures we are putting in place to deliver it, such as the appointment of Laura Magahy as the executive director of the Sláintecare office and the publication of a Sláintecare action plan in March. The action plan sets out milestones against which we will report progress every quarter using the same model as we did in the case of the Action Plan for Jobs, showing exactly where delivery is achieved.

The developments I have highlighted are only the beginning and much more needs to be done. Crucially, we must expand the workforce and infrastructure capacity in the primary and community sector, develop structures that allow for the planning and operation of services on the basis of population need and size and create an enabling environment through e-health and other initiatives. Nonetheless, I am confident that we are, at last perhaps, moving in the right direction and that we have begun the process of delivering a universal health service that offers people the right care, in the right place, at the right time.

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