Finian McGrath (Dublin Bay North, Independent) | Oireachtas source

I thank Deputies Smyth and Lahart for remaining until the end of the debate and their statements. It is obvious we agree on the importance of primary and community care services and that we wish to see more care provided at home in local communities. I accept there are gaps in the service delivery and that long waiting times for access to primary care therapy services are unacceptable. We can and must do better. We must develop a more comprehensive community and primary care system, while the vast bulk of health and social care services must be provided as locally as possible. This will not only reduce the pressure on the hospital system but greatly improve patients' experience. While implementing the change required to shift the focus of care from an acute community setting will not be easy and will take time, we must be careful to ensure the correct balance between the depth of service provision and the breadth of access, and must be realistic about the pressure that ever-increasing demand and the increased complexity of cases place on primary care services.

Despite these challenges, the Government and I remain committed to the further development of services in the community. In that regard, it is important to recognise what has been achieved. In my constituency, there is an excellent primary care service in Cromcastle Road, Coolock. I had the honour of opening that service last year and, therefore, thought it important to mention it in the debate. Primary care centres are being delivered throughout the country, while increased investment supports service delivery and will allow for 170 primary care therapists and community nurses to be recruited in the second half of the year. The strong focus of the interdisciplinary work of community health networks represents the next stage in the development of the sector. I am confident that patients and clinicians will benefit from this improved model of working.

A number of Deputies raised the issue of disability and I am delighted they did. The HSE service plan for 2019 provides for €1.904 billion in spending, or an increase of 7.5%. To listen to some of the comments in the debate, one would believe that nothing has happened on the ground. In the past three budgets, however, there has been an increase in the disability allowance of €15 and the restoration of the respite care grant, which is now called the carer's grant, to 108,000 families, while 11,000 children in domiciliary care have been given medical cards. I have been involved in the opening of 12 respite houses in 2018 and 2019. With the support of the House, we have allocated an extra €10 million for respite services. I do not suggest we have everything we want but we have started the investment and reforms. As I outlined, in recent weeks we have seen agreement on the revised GP contract , the publication of a new oral health policy and the implementation of measures to ease the burden of healthcare costs. These are important developments for the health service, clearly signalling a direction of travel towards a high-quality, integrated and cost-effective system. My focus is to build on the achievements to date in providing improved, faster and earlier access to services, as the Sláintecare action plan sets out. This will mean the following: reconfiguring health structures to deliver care based on the population size; expanding the workforce and infrastructure capacity to provide a comprehensive community based service, including prevention and well-being initiatives, diagnostic services and chronic disease management; and developing resources for primary care professionals, including the full utilisation of technology and e-health systems and the development of new funding models.

I listened to the points made by Deputies Lahart and Smyth on the assessment of need and respite, an issue we have tried to resolve in recent weeks. We are providing extra staff and resources but I accept the argument we must do something about the matter. I ask for the Deputies' support as the next Estimates approach to deal with the issue.

I am pleased to say the journey of reform is truly under way. Investment in primary care infrastructure and services represents the first step in creating a modern and improved health service to which we all aspire. I emphasise that it is the first step but we have started with the reform and investment. We need to do more and will do so.

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