John Brassil (Kerry, Fianna Fail) | Oireachtas source

As my party's spokesperson on primary care, I am delighted to have the opportunity to lead the debate. The message from Fianna Fáil is clear: robust and active primary and community care plays an essential role in enhancing health outcomes and limiting costs. A strong primary and community care system will be invaluable for preventing the development of conditions that could ultimately require acute hospital care. It will also provide a suitable environment to enable earlier discharges from hospital. From the patient's perspective, it helps to enhance quality of life and reduce the undue stress of admission to hospital.

Unfortunately, the Government's record on primary care leaves much to be desired. While more primary care centres have opened, there have often been significant delays between their announcement and delivery. In the HSE service plan for 2019, there seem to be no new measures for primary care, while on a like-for-like basis, as a share of the HSE budget, primary care has fallen from 6.9% to 6.6%. The Minister correctly pointed out that the essential pillar of Sláintecare is the improvement of primary care services. It is a simple concept. If as many people as possible in the community can be treated, they will naturally be prevented from entering an already clogged hospital system. To do that, there must be investment in capital costs to provide primary care centres. While I accept that progress has been made in this regard, much more is needed and many more structures on the ground need to be delivered. Without centres, the service cannot be delivered. Primary care centres also require staff, in the form of GPs, practice nurses, community nurses, dietitians, physiotherapists, community dentists, podiatrists and so on. The full medical team needs to be present in the community to provide the required services.

The Minister rightly referred to e-health and e-prescribing. As he knows, I am a practising pharmacist and have an interest in the area but, as I informed him at the meeting of the Joint Committee on Health last week, pharmacists are underused. In countries such as Canada, pharmacists provide a much greater role and are an invaluable addition to primary care services. As well as the unwinding of measures under the Financial Emergency Measures in the Public Interest, FEMPI, Acts relating to GPs, which I welcome, I look forward to the same happening for pharmacists and to the Minister engaging with the pharmacy sector to allow it to deliver its full potential on issues such as the minor ailment scheme and the provision of contraception.

I look forward to a new contract and pharmacists playing a much more progressive role.

The staffing of GPs is one issue we must meet head on. At present, there is a shortfall of 500 general practitioners and under current projections, we will have a shortfall of 1,500 by 2025. At present, we train 174 GPs per annum. This figure needs to double and I recommend training up to 300 GPs per annum to meet future requirements. If we can do this, we will be able to attract and retain new staff and perhaps get back many of those who have emigrated to Australia, Canada and the like.

Another issue I ask the Minister to consider is salaried GPs and salaried employees for the health system. There are rural and urban areas where practices cannot exist viably. In such circumstances, we must look at the salaried employee model. It is should be rolled out because it can work.

The Minister mentioned e-health and this is critical, as is e-prescribing. As a pharmacist, I do not know how many times over the years I received phone calls from hospitals looking for patients' medical records and drug records. Pharmacists in the country receive such calls on a daily basis. This is a total waste of thousands of man hours every week. We need integrated patient records to be available at GP practices, pharmacies and hospitals.

Universal access to diagnostics in the community is very important. If we roll out centres and have availability of diagnostics, all our chronic disease management can be done in the community, including the management of arthritis, asthma, COPD, Crohn's disease and Alzheimer's disease. We are more than capable of dealing with these conditions in the community. To do this, we must put the services in place. I will refer specifically to the care of the elderly because the increased prevalence of dementia and Alzheimer's disease is something we have to come to grips with. Many people would be more than happy to keep their loved ones in their homes if they were provided with a backup service. As I have said to the Minister and to Mr. Paul Reid and Ms Laura Magahy at committee meetings, putting the fair deal budget and the home care budget into one package would make huge financial sense. At present, the incentive is to refer anybody going to the community nurse looking for home care hours for a fair deal package instead because the money is not available in the home care budget.

In the course of canvassing two weeks ago, I came across a couple aged in their mid-90s. The woman of the house has Alzheimer's disease and she is being cared for by her 93 year old husband who has multiple medical conditions. They are getting the sum total of one and a half hours of home care per day, five days a week and nothing at the weekend. This is just not acceptable. Despite pleading as much as I could with the community nurse, she told me she does not have the money or the hours to give but that if I got an increased allocation, she would help the couple more. This issue has to be addressed as otherwise the ageing population will cause demand on our hospital system to go through the roof.

Another area of equal importance is mental health care in the community. GPs tell us they will be able to cater for 90% of mental health issues if they were given the resources in the community. This area of growing need has clogged up our hospital facilities. We need to expand primary care to deal with mental health issues. If we do so, we will go a long way towards resolving what is now an ongoing crisis.

I will work with the Minister or anybody else to try to resolve the current healthcare crisis. The key to doing so is in the Sláintecare report. The Minister has full buy-in from all of the political parties. Deputy O'Reilly was a member of the relevant committee, as were Deputy Harty and I. We have an opportunity, perhaps a once in a lifetime opportunity, to improve the healthcare of our country and give our citizens the health system they deserve. I look forward to working with the Minister to bring it about but I will hold him to account if it does not.

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