Éamon Ó Cuív (Galway West, Fianna Fail) | Oireachtas source

Tá áthas orm deis a fháil labhairt ar cheist an chúraim phríomhúil. Ar ndóigh, tá coimhlint mhór taobh istigh den chóras sláinte. An cheart an t-airgead a chaitheamh ar na hospidéil nó sa phobal? In all my time in politics there has been a great tension between expenditure in hospitals and expenditure devoted to preventive and primary care medicine. It always seemed to me that the hospitals won out. It is a more high-profile area and much more likely to attract public attention in the main national media. Primary and preventative care is less spectacular but, when analysed, gives much better results. I remember suggesting at one stage that we really need two Departments of Health. Having one Minister means that person is always conflicted between putting money into the hospitals for exciting new medicine and putting it into the much more mundane area of primary and preventative care. That might deliver better results for many more people.

There is definitely this tension. My feeling was that if we had two Ministers, one with responsibility for children and primary care and the other with responsibility for hospital care, at least there would be balance in the debate at the Cabinet table. The reality is that if we look at many of the illnesses causing so many challenges to us as a society, we see how much prevention is actually better than cure. I refer to diabetes or regular testing for cancers as examples. It is noteworthy that we are having this debate on the issue of primary care. I believe a much greater share of resources should be focused in that direction.

If we had properly funded and located primary care teams, I am convinced that many treatments now provided in hospitals could be brought out into the community. These issues date back when we were in government. No matter how often we talk about this, unfortunately, it is always stated that this is the way of the future. It never seems to happen, however. I believe in centres of excellence for high-powered medicine. That makes absolute sense. There has to be critical mass for diagnoses and operations when treating cancers, etc. It does not hold true, however, for subsequent treatments. We need to have a positive policy that everything that can be done more appropriately at the local level will be done there.

We also have to understand that for many people, throughout their lives, the mundane issues of medicine are very important. I will address some related issues in the short time that I have. As I stated in the debate on rural development earlier, there is a huge impetus towards centralisation now. When pressure comes on systems, the first places to lose out are on the periphery. It also seems that when the pressure comes on we do not do the simple things well. I will give some examples. There is an issue in respect of a lack of physiotherapy resources in the west of Ireland. The money has been provided but there seems to be some delay in hiring physiotherapists. The existing resources were not spread equally across the regions to ensure that any reduction in services would be borne evenly between urban and rural communities. A decision was made by the HSE instead to withdraw physiotherapy services from Connemara and to tell people to travel more than 100 km to Galway city for physiotherapy. It is absolute nonsense to be recommending that older people who need these services be brought such distances on bad roads. I recall the old saying about bringing the person to the mountain or the mountain to the person. It seems that in this case we are bringing all of the people to the city instead of bringing the services to the people.

This is a major reversal all of the promises made regarding primary care. I have an example in which the Minister of State may be particularly interested. Someone recently approached me in respect of the child and adolescent mental health services, CAMHS. That person lives seven miles west of Clifden, County Galway. Clifden is about 100 km from Galway city. The suggestion was there be a CAMHS service in Clifden once a month. I asked a parliamentary question on this issue. It was, as usual, referred to the HSE. That agency responded that that was its policy and the patients would have to go to Galway. Is that a humane way to treat a family under stress and the young person with mental health issues? Is it fair for that young person and his or her family to have to spend half a day travelling to avail of a service? Is this what we call progress? We are centralising everything and putting great impositions on people on the edge. We wonder sometimes why the emergency services are jam-packed. We wonder why ambulances are held up in the acute hospitals waiting to disgorge patients. The patients can be brought into the hospital but they cannot be handed over to the staff. The lack of a local primary care service is forcing people who could have been treated in those services into the acute hospitals.

In the time left to me, I want to raise a subject that might not be the exact topic of this debate but I am sure the Minister of State will forgive me. It is his specific area of competence. I am gravely concerned about the dearth of funding for disabilities services in recent years. I am criticising the Minister of State and the Government but I am not doing it in a personal way. I am doing it because a great many parents are coming to me looking for respite care. Some are looking for full-time residential care.

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