Thomas Pringle (Donegal, Independent) | Oireachtas source

Primary care has really been a pipe dream since its conception. It is true that a new primary care centre has been approved in Donegal town and in Buncrana. However, the primary care project has been largely private sector-led, delivered by private developers offering up sites for primary care centres, which says a lot about healthcare in Ireland. The Government justified this by arguing that it is better for the delivery of healthcare and costs less as it pays a lease over 20 years instead of all at once upfront. However, the direct consequence of this Fine Gael way of thinking is there will be large gaps in the provision of primary healthcare. This is the case in my home town of Killybegs. We are unfortunate because we do not have a private developer. We have GPs but no private developer is willing to develop a primary care centre, meaning that one will not be provided. This Government, supported by the Independent Alliance, makes sure that this is the case.

The consequences are that the existing GPs are working out of a small health centre and cannot adequately meet the demands of the community. The closest primary care centre is Ballybofey or Ballyshannon, approximately 50 km or 60 km away. GP surgeries are available intermittently, but the idea is that health services are only based on a private sector model. Once again, we are at the mercy of the will of private developers and of course, by default, Donegal will lose out by virtue of the fact there are fewer private developers there. My colleague, Deputy Connolly, mentioned the islands off Galway which are crying out for primary care centres. If they had private developers there they would be tripping over themselves to build brand spanking new primary care centres.

We need State-run community healthcare with State-owned facilities. This will meet the needs of local communities upfront and into the future, as the asset remains State-owned. Tailoring health services according to what the private sector is offering, instead of deciding what we need, means that the facilities provided are entirely at the discretion of the private sector. There should be integrated settings that provide a range of ongoing services for common illnesses and conditions to which much of our population is or will be exposed as people age. For example, the Donegal branch of Diabetes Ireland has done much to raise awareness of the chronic lack of diabetes services across the county, despite ever-increasing demand for health services for people with this condition. It is a condition that does not discriminate against age or gender and is even increasing in school-age children, yet services still have not caught up. Diabetes can cause other health conditions affecting the kidneys, eyes and heart, and can cause blood pressure problems. Constant care is needed to ensure that persons with diabetes do not see their health worsen. This could be dealt with in primary care settings.

There is a significant lack of staff in clinics across Donegal, threatening the expansion of the primary care project. While cancer care is largely hospital-based, we still face the same problems. I have worked closely with Donegal Action for Cancer Care on this issue and have constantly pursued both the HSE and Letterkenny University Hospital on increasing access to services in Donegal. We still do not have adequate access to certain healthcare through our own hospital, let alone services being provided in a primary care setting. For example, men from Donegal must travel to the prostate rapid access clinic at Galway University Hospital. Some travel six or seven hours for treatment and must have their follow-up treatment there, if required. Better access would mean providing a prostrate rapid access clinic through Letterkenny University Hospital. Donegal women should not have to travel to the centre in Galway after having their BreastCheck mammogram if there is a query or concern. Donegal women should be able to be seen at Letterkenny University Hospital and, if required, have their surgery there.

With radiotherapy services at the north-west cancer centre at Altnagelvin hospital, in which the Government has invested, has a memorandum of understanding for 25 years, both the rapid access clinic and BreastCheck follow-up should be at Letterkenny University Hospital. All Donegal patients who need radiotherapy which can be treated at the north-west cancer centre at Altnagelvin hospital should have their treatment there and not be forced to travel to Galway and Dublin.

Importantly, we need investment in mental health services more than ever and placed within a primary care setting particularly in the area of child and adolescent mental health services, CAMHS. Findings from a national survey revealed that over 40% of service users indicated they had a poor experience of HSE mental health services. Almost 40% indicated they were not involved as much as they would like in decisions about the medication they take, while two thirds reported they did not have a written recovery or care plan developed with their community mental health team. Over 70% of family, friends, carers and supporters were dissatisfied with the extent to which HSE mental health services had considered their support needs. Almost half indicated none of their views had been incorporated into the recovery or care plan of the person they support. If a survey was done of the private developers who provided the primary care centres, I am sure it would find they would be happy with the service. That is probably where the service will be heading.

In a reply to my query recently, the HSE acknowledged one vacant consultant psychiatrist position within CAMHS, with numerous vacancies in nursing, health and social care professional categories, including one senior occupational therapist, one clinical nurse specialist as well as one principal social worker. The constant vacancies and issues retaining staff are at crisis levels and will severely hamper any effort to roll out effective primary care. It is time we move away from a private sector model and towards State-owned, State-run local community health care. It is a human right not a commodity. The Minister of State will claim that the private model is cheaper in the long run when it is not. It just provides fewer outcomes at the start. I would rather have fewer proper ones than more defective ones.

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