Louise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

The health service is our most important public service. It is there for us when we are born, throughout our lives and at the end. The health of our nation is Sinn Féin’s number one priority. Sinn Féin has a very simple vision and commitment that healthcare should be free at the point of delivery and available to those who need it based on their clinical and medical needs and not on their ability to pay. Unfortunately, time and again we see that those who have a few extra bob in their back pocket can skip the queue. Children in my constituency will wait 30 months to access a diagnosis. We often say that diagnosis is the key to getting into the system but if people have to wait on that diagnosis and wait three years for what is called early intervention, they find it very hard to see neighbours who might be in a better financial position skipping the queue. For this reason, Sinn Féin believes healthcare should be available based on need and never on ability to pay.

Key to this delivery is the development of primary care services and the delivery of GP and community-led care. General practitioners and those who work with them are the cornerstone of our primary care services. We must ensure that we have a supply of GPs for the whole of the State. Primary care is very much the absolute front of the front line. It should be the coalface for dealing with the bulk of the health needs of the population. We know it is cheaper than acute care and can deliver better quality preventative care faster and closer to home. People end up in hospital when primary care has failed, they have been unable to access primary care or the State has failed to provide accessible primary care for them. This means not only that we must train more GPs but also that we must make the profession more accessible and attractive through lifting the burden of uncertainty created by self-employment and creating directly employed GPs. I have been calling for this since long before I came into the House. We need a mix of self-employed and directly employed GPs. This would allow doctors to be doctors and not have to worry about renting a building, paying the electricity bill, employing a practice nurse and a secretary and all that goes with running a small business. It would mean directly employed GPs with a yearly HSE salary and all of the rights that accompany direct employment, such as maternity, paternity and annual leave and a pension. I believe this would make the profession significantly more attractive.

We also need to ensure that primary care centres are properly staffed and have a full complement of staff. The Minister has heard me say this before, but in case he was not listening on the million other occasions although I know he does listen, I will raise the issue of Balbriggan primary care centre, a lovely primary care centre in my constituency, just up the road from my house.

No additional staff were provided for this centre. I have raised this issue many times and on each occasion the response was that services will be provided from within existing resources, which is code for there will be no additional staff. Despite the rapidly growing population in Balbriggan, there is no diagnostic equipment in Balbriggan primary care centre. When I raised this issue recently via a parliamentary question the response was that there are no plans to provide additional diagnostic equipment. We have not yet had sight of the capital plan as we approach the end of May. I sincerely hope that not much more time will pass before we see it and that when we do, there will be something in it for people in Balbriggan. As recently as last week, as per the response to my parliamentary question, there were no plans to install diagnostic equipment or provide additional staff. I understand that this is a local issue but this situation is replicated in many primary care centres, making it a national issue.

Another response to a parliamentary question indicated that one in five primary care centres around the country has failed to attract a general practitioner. The Minister has pledged to deliver primary care. The Minister is not a doctor and nor am I but there is a doctor in the Chamber. Primary care is not possible without general practitioners. It is startling that approximately 26 of the 126 operational primary care centres, which are supposed to be a one-stop-shop for people's basic health needs outside of hospital, do not have a general practitioner. Without general practitioners these centres cannot deliver care. The lack of staff to deliver primary care calls into question the Government's commitment to primary care.

The newly built primary care centres have each cost millions of euro but they are not being properly utilised. For example, Boyle primary care centre in Roscommon cost approximately €6 million to build. It opened last August and it still has no general practitioner. These centres are supposed to be staffed by a general practitioner and other health professionals such as physiotherapists, occupational therapists and counsellors. According to the figures provided to me, 15 primary care centres were without psychologists and 19 did not have a single social worker. This seriously undermines the Government's claim that it is committed to Sláintecare. We all know that we need to shift to primary and community care. That argument has been won. There were many battles in that regard years ago but, as I said, that argument has been won. Sláintecare has gone a long way towards ensuring that argument was won. The move to primary care is essential. It will take the pressure off acute services but we will never deliver free GP care without general practitioners and the facilities from which they can operate.

The Minister told us he would introduce a new contract for GPs. I understand there is a commitment to unwind FEMPI, which, I know, is extremely important, but where stands the delivery of a new contract? A revision of the existing contract will not suffice. We need a detailed contract which is fit for the 21st century. As I said previously, the issue of salaried GPs needs to be examined. Directly employed GPs means doctors can be doctors. We need to examine how the dual model might work. The self-employed model has worked well in some but not all circumstances so we need to examine how the dual model might work. There is definitely a space for it.

Any party that is serious about delivering healthcare to communities and the people who need it must be serious about primary care. As I have said, that argument has been won. We no longer hear people arguing about the need to increase staff numbers in acute care, which is already overstretched as the Minister will know. The argument has been won in regard to primary care. What is lacking is the vital investment to ensure our primary care centres are one-stop-shops. I refer again to the primary care centre in Balbriggan. While it is not the most beautiful building, the inside is lovely and practically laid out but it lacks staff. The population of Balbriggan is growing and there are no plans for additional staff or diagnostic equipment at this centre. People who live in Balbriggan still have to travel to the Mater Hospital in the city centre for a diagnostic test. This makes no sense. This service could and should be accessible in Balbriggan or north County Dublin. The test in terms of the Government's commitment to the delivery of primary care will be its capacity to deliver fully staffed, equipped and functioning primary care centres.

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