Catherine Connolly (Galway West, Independent) | Oireachtas source

I welcome the opportunity to participate in this debate, although I wish that rather than statements on primary care, we were getting an update from the Minister for Health, Deputy Harris, on the 2001 report, Primary Care - A New Direction, and what parts of it have and have not been rolled out. Primary Care - A New Direction was produced 18 years ago. We were told at that point that primary care is the appropriate setting to meet between 90% and 95% of all health and personal social services need; that primary care needs to become the central focus of the health system; that primary care has to be rolled out; and that we need an interdisciplinary and multidisciplinary team based approach and so on. As Governments of various persuasions are inclined to produce a report and not follow it up, we were told a national primary care task force would be established. Does the Minister recall A Vision for Change and the implementation body? It did such a good job over two to three years the Government dismantled it.

In regard to primary care, a task force was to be established. There were to be 20 actions, including a community based diagnostic centre pilot and an implementation plan. An implementation plan for primary care is outlined in the 2001 document. The Minister might consider reading it. On physical infrastructure, it states that modern, well equipped, accessible premises will be central to the effective functioning of the primary care team, a national primary care task force will be established and evaluation is absolutely essential to implementation. That is plan number one. There are many other plans, including one from the Adelaide Health Foundation. There are many recommendations in it tangential to the 2001 report. It refers to the need to future-proof the health system, to borrow ideas from abroad and, interestingly, to promote parity between physical and mental health in practice, not just in rhetoric, to recognise and plan for the co-existence of physical and mental health morbidity in patients and to provide services that are in a position to respond to this type of complexity.

Then came the Sláintecare document, which was brought about by the range of voices in the new Dáil calling on the Government to do something about our health services. Ireland distinguishes itself among its European colleagues by not providing universal equitable access to either primary or acute hospital care. The Minister opened this debate with a statement, which I will try to balance that with what is happening in Galway city and county. There is a health centre in Connemara. I will spare the doctors' blushes but I will refer to a sign therein which states that private patients must pay €20 for blood tests and medical cardholders must pay €10 for blood tests. This sign features in various doctors' surgeries throughout Connemara. The health service response is that it is provided in the contract that blood tests should be provided free of charge.

There was obviously a disagreement but that is the result for people on the ground.

I recently asked a question about social workers in Connemara, the waiting list and the number of vacancies. In the response I eventually got, I was told that there was no waiting list for social workers in Connemara because there were no social workers in Connemara. I appreciate the sense of irony and honesty of the man who responded to me, in that there is no waiting list because there are no social workers in Connemara. There are no physiotherapy services in south Connemara so potentially vulnerable people of all ages are brought from Connemara to Galway. Tá siad ag iarraidh seirbhís a fháil trí Ghaeilge, ach níl sé le fáil san áit ina bhfuil siad ag dul. Tá orthu teacht tríd an tranglam tráchta i lár na cathrach chun seirbhís trí Bhéarla a fháil i gCaisleán Nua, agus ansin tá orthu filleadh ar Chonamara. They have to come in from Connemara to get physiotherapy in places where services are provided in English, not in Irish, adding to the traffic congestion and all sorts of problems. I sometimes cannot put words to what I feel when I hear speeches in the House about primary care, mental health and new ways of doing things when all of these problems were foreseen and solutions were given. We went forward to build primary care centres. In Galway, in Doughiska, we are paying over €250,000 in taxpayers' money on rent for a private building every year. On the west side of the city of Galway, we have no primary care building.

In the bad 1980s, I had the privilege of working in what was then called community care, in a multidisciplinary team, where somebody could walk in and see a psychologist, speech therapist or social worker. We thought things were improving. We now have all these beautiful reports and all this lovely language but things have actually gone backwards. In addition, we are paying high rent for buildings that should be publicly owned. If we were seriously interested in primary care and taking the pressure off acute hospitals, we would roll out public buildings throughout the country where we would locate essential services and take account of the regional balance. We would certainly take account of the needs of those living in the Gaeltacht agus seirbhísí trí Ghaeilge ag teastáil go géar uathu.

The Department of Health's report, Future Health: A Strategic Framework for Reform of the Health Service 2012-2015, stated that primary care teams must form part of the dedicated facilities and no one must pay GP fees. GPs must work with other primary care professionals. Staffing and resourcing of primary care must be allocated rationally, and there is a great absence of rationality, to meet regularly assessed needs. Structurally, primary care in Ireland remains highly fragmented. It involves a mixture of public and private patients, which is not an efficient or equitable way of arranging healthcare. Despite this, we are subjected to this speech all over again. I have said a number of times that whoever writes these speeches should perhaps read the reports first and look at the recommendations. One can look at any period one likes, which is 18 years in this case, and work from the original report.

I will finish with a review of primary care island services. I know it is difficult and that the Minister is busy. We are all busy. I find it increasingly difficult to keep up with all the reports but we have a duty to read them. There is certainly a duty on whomever writes the speeches to read them. A review was carried out on all our islands in April 2017, including the Irish-speaking islands. It was a very good report but it was not published until earlier this year with no explanation given for the delay. It tells us, among many things, of the essential need for primary care services on the islands where we do not have hospitals. It then looks at Galway, Inishbofin and Árann, where we have health centres that are not fit for purpose. These are simple practical matters. There are health centres which are not fit for purpose on the islands of Inishbofin and Árann. Níl siad cuí. There are many other recommendations in the report relating to the Irish language and so on which I will not go into. I accept the Minister's bona fides on many subjects he has spoken on in the Dáil but at the end of the day, the proof of that lies in what was on the ground in these reports and was not on the ground. He should tell us what has happened and why we cannot roll out public buildings for primary care if we are seriously interested.

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