Fiona O'Loughlin (Kildare South, Fianna Fail) | Oireachtas source

I am delighted to have this opportunity to make a few points to the Minister of State on the development of primary care. This is an important aspect of Irish life and it is important that we get it right. It is said, and I can only conclude it is correct, that we should seek to meet 90% to 95% of all health and personal social service needs within a primary care setting. That is something towards which we should aim.

Robust and active primary and community care is essential in terms of enhancing health outcomes and limiting costs to the State. A strong primary and community care system will be invaluable in preventing the development of conditions that could ultimately require acute hospital care and it would also provide the right environment for early discharges from hospital. It helps to enhance quality of life and reduce the undue stress of admission to hospital from a patient’s perspective. The Government's record on primary care leaves a lot to be desired. There have often been significant delays between announcement and delivery of primary care centres. We have been waiting quite some time for a primary care centre in Athy. There were a number of photo opportunities on the site. When it is developed it will be good and will have many specialised services, but there has been a long gap between announcement and delivery.

There are no new measures for primary care in the HSE service plan for 2019. On a like-for-like basis, as a share of the HSE budget, the allocation will fall from 6.9% to 6.6%. That shows us where primary care is ranked. When we compare the figures, 6.6% of the total HSE budget is to be spent on primary care when it should be looking after 90% of people's needs. There is something wrong.

I want to mention a few areas I highlighted recently by tabling parliamentary questions and raising matters for Topical Issue debate. I spoke about the lack of GPs in Kildare, particularly in Kildare town where, following the retirement of a GP, people were told that they had to go to Monasterevin, which is a number of miles away. We are talking about many elderly people in their 70s who might find it difficult to access public transport or to drive themselves there. That has been difficult for them. There is a significant capacity issue, certainly within Kildare and across the country.

I doubt this is the case only in Kildare but there is a large number of issues in terms of the parents of children under the age of age who are having difficulty enrolling their children into a GP practice. Kildare is in the lowest 20% nationally for the number of GPs per head of population. A total of 15% of GPs in Kildare are set to retire in the next ten years and succession planning cannot take place due to the fact that there is no established feeder scheme into the county. That is a major problem.

Another issue I raised is the lack of resources to provide a replacement for the primary care psychologist for the Kildare area while she is on maternity leave. A replacement was not sought to cover maternity leave for the Kildare and Wicklow area. Many children are waiting for assessments and to think that they have to wait for at least another six months is shocking. I was contacted by one family who is paying more than €1,000 for a private assessment having waited many months for any type of assessment. In a reply to a parliamentary question I tabled, I was advised that the reason a temporary replacement has not been found is due to a lack of resources. They did not advertise due to a lack of resources, which is shocking. How can resources be so low that they cannot look for a replacement to continue a service across the Kildare area? It is scandalous that parents are being left in limbo while awaiting an assessment for their children.

My colleague, Deputy O’Dea, with the support of the Fianna Fáil Party, introduced a Private Members’ Bill on providing a fair deal on home care. It is a valuable Bill. I keep in touch on an ongoing basis with the Alzheimer’s Society in Kildare. I attended a meeting not too long ago at which I met many wonderful men and women who, with the right supports, have remained in their own homes and the familiar environment which is best for them and with their children and spouses caring for them. However, they face many challenges, as all families do, in dealing with dementia care. Thousands of them across the country are selflessly caring for older relatives with very little help from the Government. Staying at home with appropriate assistance from the State and appropriate primary centre healthcare is, without doubt, the preferred option for most of the people I have met and spoken to in my constituency week after week. They deserve dignity, respect and the choice as to where they want to live the final years of their lives. Not only is that the most humane solution but it is the best value for money for the State coffers. It is important that we examine that. We as a party believe that funding allocated to enable older people to remain at home with the support of primary health centres provides the best value for money and the fairest and most dignified result for older people. Progress needs to be made in that regard.

A strong primary care system would be invaluable for preventing the development of conditions that ultimately require acute hospital care. We need occupational therapists, physiotherapists, psychiatric nurses, speech therapists and many more to help plug the gaps in primary care. Continuity of care is crucial for everybody.

The 2018 service capacity review states that if reforms are to be implemented, there would be a requirement for a 50% increase in the primary care workforce, including approximately 1,000 extra GPs, 1,200 extra practice nurses, and 1,100 extra public health nurses. The Government's 2019 primary care plans do not match its supposed commitment to the sector. Certainly, the programme for Government commitment of a so-called decisive shift in health service practice to primary care is not supported in the HSE service plan. This is not good enough. An increase of 0.5% in the allocation for new developments in primary care was held back by the Department of Health last year. We had a similar situation in 2017 and 2018. In late 2017, the then director general of the HSE stated that the health service required an additional €500 million a year of transitional funding over ten years to move to a properly functioning primary care GP-based system. This should be a priority for the Minister of State, Deputy Finian McGrath, the Minister, Deputy Harris, and the Department of Health.

In a contribution to A Future Together: Building a Better GP and Primary Care Service, the former HSE director general stated, "We need a ... substantial transitional investment ... to move from the overly hospital-centric system we have now". Part of the problem is that doctors are incredibly cautious. That is my experience. They are afraid to make judgments and are sending many of their patients into accident and emergency. That is wrong. It is no wonder that we have a choked-up system. In Naas, we have people on trolleys every night. In Naas, one of the medical assessments is closed because they cannot get a doctor. That is adding to the problems there.

On behalf of the people I represent in south Kildare, I appeal for increased investment in primary care for the people whom we serve in this House.

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