Michael Collins (Cork South West, Independent) | Oireachtas source

The development of primary care is vital in reforming the health services. We need to look at ways of achieving a more balanced health service by ensuring the majority of patients who require urgent or planned care are managed within primary and community-based settings. This will achieve a more accessible and cost-effective health service for the benefit of everyone who uses it.

The document, Primary Care: A Framework for the Future, which issued in April 2016 when the Government took office, sought to outline the challenges that healthcare in urban and rural Ireland presented, and outlined possible solutions to these problems. Primary care teams in both urban and rural Ireland are undoubtedly dealing with a raft of challenges, and my main concern in our discussion is how primary care can function better in my large rural constituency of west Cork. I have spent recent months out on the road canvassing for my brother and from meeting my constituents during that time, I am aware of the following problems we face in west Cork when it comes to primary care such as the ageing population, the lack of available GPs, and diminishing services in rural primary care centres, to name but a few.

The ageing population needs to be cared for, either in their homes or in nursing homes. Parts of rural Ireland, however, are facing a bed shortage in nursing homes. Current projections suggest a shortfall of up to 7,500 beds by 2026. The HSE home support service, formerly called the home help service or home care package scheme, aims to support older people to remain in their homes for as long as possible and to support formal carers. From listening to my constituents, however, this vision of the home care service as portrayed by the HSE is a far cry from the reality faced by elderly people longing to stay in their homes. Many are lucky if they can get an hour a day of home care service. Most get only a half hour. Only the other day a lady in Bantry told me that when the family were looking for a home care service for her father, they were told there is an embargo on it. They will stop it altogether soon. Of course, we are told time and again that there are no hours available because they cannot find staff. Those carrying out the home care services are fiercely interested in getting extra hours but they will not be given them. It is a game. There appears to be a disconnect between each patient's needs and the services and facilities that are provided. There is no statutory right to home care in Ireland. The quality and availability of information about services is poor. This is difficult for families in trying to navigate the system and access services. We need to address the shortage of home care staff. This is a serious concern.

I commend the public health nurses who do a wonderful job, but there are not enough of them within the HSE to provide the service that is needed. This staffing issue results in too much responsibility resting on the shoulders of the understaffed public health nurses. They have too many decisions to make and too much to cope with and they do not have enough time allotted to carry out their jobs. There needs to be an increase in the number of public health nurses.

GPs are facing a manpower crisis. Approximately 55% of GPs are over 55, and many newly trained GPs are leaving Ireland to work abroad where pay and conditions are better. This shortage is particularly evident in rural areas, especially with many of the GPs close to retirement age with no great prospect of being replaced. Practising GPs report that they are in a situation of burnout and stress. This is another serious issue that we need to address.

Rural GPs are finding it increasingly difficult to run a viable practice in a small town or village, as the number of public patients in rural areas is increasing. The GP is still expected to maintain a properly equipped, technologically enhanced premises, employ expert staff in sufficient numbers and manage a range of expenses. It is now becoming impossible for a GP to run a viable practice in a small rural community.

I am also concerned about the diminishing services in rural primary care centres. In my constituency, there was a chiropody service in Schull which facilitated a large number of older members of the Mizen Peninsula. I am saddened to say this service was stopped in December 2018, and patients now must travel to Skibbereen Community Hospital to avail of this service. The additional patients have put increased pressure on the staff in Skibbereen. Many of the patients from Schull do not have their own mode of transport and there is no public transport from Schull passing the hospital, which is a few kilometres outside of the town.

It is welcome that new primary care centres are being built in Bantry and Bandon in west Cork. Bantry's new primary care centre will be a large building, set beside Bantry General Hospital. Among other services which will be provided there, this large building would provide an ideal location for a cataract unit. With considerable waiting lists for cataract surgery in west Cork, a cataract unit is essential to cope with the increasing numbers of patients coming on stream every year. At present, we have people on waiting lists up to five years for a cataract procedure that takes 15 minutes. It is a disgrace that they have to travel across the Border to save their sight. The Government appears to have no problem with allowing people to go slowly blind while waiting for their cataract procedure. So far, Deputy Danny Healy-Rae and I have carried 33 busloads - the 34th this weekend - to Belfast for cataract procedures. The Government should be ashamed of how it has let down the people of the country.

Earlier this week I raised a question in the Dáil about the charity-led air ambulance, which is based in Cork and has the capability of reaching out to most parts of Ireland, including remote areas in west Cork such as the Beara, Sheep's Head and Mizen peninsulas, within ten to 15 minutes. The development of the charity-led air ambulance has been delayed for months which has led to considerable frustration as this has the capability to save so many lives. It must be remembered that people have raised tens of thousands of euros and have put this in place. The effort some of these people put into this is incredible. It is sad to think that it is lying idle waiting for the HSE to tick the box, which I cannot see happening. This charity has complied with the required procedures and protocol, but we are faced with the situation that this lifesaving resource is still grounded. I want to know when the National Ambulance Service will confirm the deployment of this national lifesaving service. I have asked previously. Yesterday, I was told by the Minister, Deputy Humphreys, it was not on the programme for Government. It actually was. The Minister must correct the record and I will be notifying her. The national air ambulance service was on the programme for Government. We need to make sure that this service gets off the ground and is used. It is also not only for west Cork. It will be used all the way up to Galway, Mayo, etc. It will provide an excellent opportunity to save lives.

I cannot stand in front of the Government and talk about primary care services without mentioning how the ambulance staff have been reduced to strike action again.

The ambulance personnel belonging to the Psychiatric Nurses Association are to escalate their campaign of industrial action by engaging in strike action in six days' time because of the refusal of the HSE to afford its members the right to be members of a union of their choice. The first of these strikes will take place this Friday and Saturday. Once again, the HSE is forcing an escalation of this dispute which is entirely of the HSE's making. I support the ambulance staff 100% and will be standing beside them this weekend during their strike to show them my committed support.

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