Barry Cowen (Offaly, Fianna Fail) | Oireachtas source

I welcome the opportunity to make a contribution to the debate on the development of primary care. I acknowledge the Government's policy, which seeks to provide robust and active primary and community care. We all agree that it could and should enhance outcomes and limit costs. Sláintecare reaffirms the commitment, which is representative of all parties and none. In the absence of that being delivered in a timely manner, the responsibility for the provision of primary care and the advancement and its delivery rests with the Government.

It is opportune to speak on the topic at this time considering the level of engagement and conversation we have had with constituents, let alone the information that comes into our offices on a daily basis on the difficulties with the Government's implementation of the policy. At a time when there is grave difficultly in seeking to meet the demands of the policy and match the rhetoric with action on its implementation, parallel to that the Government is engaged in turmoil in terms of the overspend of €400 million on the national children's hospital. Likewise, in spite of the great delays that existed heretofore, regarding the provision of a national broadband plan and the vast and mammoth cost associated with that and the lack of clarity on a contract, there is no lack of clarity on the cost associated with such a mammoth project, amounting to an additional €1.9 billion, which is new money that must be found. That is despite the commitments made by the Government on current expenditure and the national development plan. The Minister for Finance and Public Expenditure and Reform said the moneys will come from future revenues, despite the fact that he made commitments on future expenditure based on Estimates. He now says there will be no impact on taxation. There will be no new taxes. There will be no new borrowings and there will be no cuts or projects forgone within the national development plan. It is magic money. It is Freddie Mercury stuff – A Kind of Magic, but it is not real. Then there are the difficulties we all witness with housing, health and Army pay, among others. There is no magic money to resolve those issues. It is my duty and that of anybody in this House to highlight the lack of delivery and action to match the rhetoric on the delivery of primary care.

Home help packages and hours are not available, or are being turned down in my constituency. Some progress was made at the beginning of the year but it would appear that this was because of the extra funding made available to the HSE to manage the winter crisis in hospitals.

There is a crisis in the area of housing aid for the elderly and disabled. Local authorities, which administer some of the funding in this area, have waiting lists of two to three years. We all want our elderly to remain in their communities and remain with their families, but they are being forced to look at the fair deal scheme in the absence of adequate funding being available to them to make their homes compatible with their needs in relation to community help and assistance and home help from the primary care sector. The costs associated with the fair deal scheme and nursing home care are far greater than what would be expended on these areas.

There are also astronomical waiting lists for psychological assessments for children. My constituency of Laois-Offaly now has the longest waiting list, having taken over from Cork. Other speakers have raised the lack of available and meaningful services in the mental health sectors. Communities are unable to meet the demands of their inhabitants. The time has come to take on board the suggestion made by Deputy Brassil and others to the effect that the funds within the fair deal scheme should be permitted to be directed towards home help packages and be used to adapt homes for the elderly, meeting the demand. The fair deal funding should also cater for specialist care for dementia and Alzheimer's patients, which has been neglected by the Government, despite its rhetoric.

I acknowledge the progress that has been made, albeit slowly, in terms of primary care centres and the professionalism that will bring. However, the provision of a primary care centre in the absence of GPs is a square that must be, but has not been, circled. I have had first-hand experience of the loss of the Midoc services and the loss of out-of-hours services from GPs. We were told by the HSE and members of the profession that such losses were caused by an inadequate GP contract and an inadequate rural allowance. We now hear that the new GP contract, which has been lauded and heralded by members of the Government, is a panacea for these issues. However, it has not resulted in the reinstatement of those services in places like Birr. Someone must ask whether the GP contract is adequate to meet the demands of a rural town like that. If it is not, that should be acknowledged and admitted and such a contract should be put in place to adequately provide for such demands.

We had statements on rural development earlier. A Minister for Rural and Community Development was appointed to the Cabinet in this Government. We were assured that all Departments would be rural-proofed and that no policy would emanate from any Department without adequate provision being made for rural areas. The provision of primary care, home help, adequate facilities and GPs and out-of-hours services is lacking in many parts of rural Ireland, including in my constituency. This speaks of a failing not just of the Department of Health but also the Department of Rural and Community Development. The Government should insist on facilities to meet the demands of such communities. I have outlined some hard facts about the issues we face on a continuous basis which are not being addressed despite utterings to the contrary. The GP contract is a case in point but I could give many other examples if I had more time. We will have ample opportunity to examine this further in the coming weeks and months as we prepare for a budget, notwithstanding the difficulties with that in its own right, considering the promises on the delivery of services during negotiations for the last budget that have not materialised. That, however, is a discussion for another day and for future negotiations. We will see where they will take us.

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