Carol Nolan (Laois-Offaly, Independent) | Oireachtas source

I move:

That Dáil Éireann:

recognises that: — healthcare General Practice, being the patient's first point of contact with health services, provides person-centred and comprehensive care from the beginning to the end of life, often coordinating care between many agencies involved in the treatment of complex chronic illnesses;

— general practice in Ireland, providing professional quality care at the heart of the local community, is the cornerstone of the Irish health service, with General Practitioners (GPs) being the first port of call for most patients;

— over two-thirds of GPs (66 per cent) in rural Ireland are currently unable to take on new patients, with some reporting waiting times of up to two weeks for an appointment, according to a survey by the Irish Independent;

— the Irish Medical Organisation warns that Ireland, having only seven GPs per 10,000 population (one of the lowest in the European Union), falls well below the required minimum of 12 per 10,000 to ensure a safe and effective healthcare service;

— Government policy and planning has failed to ensure Ireland is training enough GPs for the population increase, leading to many GPs emigrating due to better pay, terms, and conditions abroad; in 2022 alone 442 Irish doctors were issued temporary work visas for Australia;

— the recent Irish Independent study highlights a mounting health crisis in rural Ireland, whereby a severe lack of healthcare accessibility is causing strain on residents and leading to delayed diagnoses and treatments;

— over two-thirds of GPs are currently not accepting new patients which signifies a shrinking healthcare horizon in rural Ireland;

— medical services in rural communities are currently unsustainable, as evidenced by patients reportedly waiting up to two weeks to secure a GP appointment;

— despite warnings from the Health Service Executive (HSE) years ago, little or nothing has been done at senior Government levels to address this unfolding crisis; and

— modelling suggests that by 2025 Ireland expects a shortage of between 493 and 1380 GPs, mainly in rural areas; this, coupled with an aging population and the likelihood that many GPs are due to retire by 2026 (expected to be around 700), paints a grim picture for a rural health service that is being hollowed out due to a lack of political support; notes that: — according to the Irish Independent study, 68 per cent of medical practices outside the country's main cities are not open to taking on new patients, reflecting a clear urban-rural divide;

— the urban-rural divide in healthcare access has stark implications, with rural patients facing significant barriers to timely medical care, despite rural areas having an older population compared to urban centres in Ireland;

— the cumulative effect of a lack of access to GPs in rural areas has led to an alarming rural health crisis, which is exacerbated by limited or absent public transport services making health services less accessible to rural people;

— the Irish Independent study found that, on average, patients in Dublin can be seen on the same day as a request for an appointment, while those in the midlands looking to book a non-urgent appointment with their GP could be waiting up to two weeks;

— the rural health crisis extends beyond patients to GPs in rural Ireland, with many practices closing down and the remaining ones grappling with overwhelming workloads due to a lack of support from the Department of Health and the HSE, resulting in onerous working conditions that deter new GPs;

— GPs often cite high insurance costs, overheads, and an overly bureaucratic system as obstacles to their patient-centred role, all of which are issues that the Government can address;

— the rural healthcare crisis extends to an emergency in dental care provision where children are forced to wait up to ten years for treatment and less than half of eligible children were seen under the school screening programme last year;

— the rural healthcare crisis is further exacerbated by a severe shortage of home helps, a worsening crisis in every accident and emergency department, an almost non-existent mental health care service, and a severe lack of residential places for people with physical and mental disabilities;

— the Irish Dental Association has previously highlighted to the Oireachtas Joint Committee on Health that children are waiting up to ten years for treatment and less than half of those who were eligible for the school screening programme have been called for treatment;

— the number of dentists registered to treat patients under the Dental Treatment Service Scheme is in freefall, requiring a complete overhaul of the contract governing the scheme; and

— the failure of the Government and the Minister for Health to address the unfolding rural healthcare crisis will likely have a grave negative effect on the health and life expectancy of the rural population; and calls on the Government to: — accept that the leading cause of the severely diminished access to healthcare provision in rural areas is Government neglect and inaction in adopting a strategic rural healthcare framework that incorporates increased resources by the Minister for Health and the HSE;

— end the policy and practice of addressing all healthcare policy problems through a narrow Dublin-based approach, and recognise the healthcare problem in rural Ireland, accepting that rural residents deserve equal access to healthcare;

— explain how, despite an increased national health budget, the country is witnessing a steady deterioration of health services, especially in rural communities;

— urgently address the rural health crisis by establishing a high-level Ministerial working group or Cabinet sub-Committee to generate immediate, medium-term, and long-term solutions, and report to the Dáil within four weeks from this day with a strategic roadmap to reverse this decline;

— immediately implement a strategic 'rural proofing' and 'patient first' approach to all healthcare policies;

— acknowledge that trying to recruit more GPs or allied health professionals from abroad is unlikely to succeed given the global shortage of both these groups of professionals;

— increase the number of GPs through sustained Government funding and a long-term GP workforce strategy and plan, addressing the unhealthy work climate for GPs by improving support, reducing their administrative workloads, and tackling their patient workload intensity and volume, as well as long hours;

— implement policies that will make the provision of rural healthcare attractive for young doctors, such as offering scholarships to medical students from rural areas to return and practice in their home areas;

— ensure the HSE changes policy and puts in place new salaried GP posts where vacancies remain unfilled in rural areas, along with providing premises and staff in areas where the patient list is small; and

— recognise that action is long overdue and the fact that Ireland does not have enough GPs to meet patient numbers, especially in rural Ireland, which constitutes a national health emergency that needs to be treated as such.

I am delighted to move the motion on my behalf and that of my Rural Independent Group colleagues. Before I begin, I convey my sincere condolences and those of the group to Deputy Michael Collins and his extended family on the death of his nephew, which is no doubt a devastating tragedy for them all. Our thoughts and prayers are with them all at this very difficult time.

It is absolutely clear that for many years now rural communities have been struggling to attract and retain GPs and locum GPs. The HSE's own modelling suggests that by 2025, Ireland expects a shortage of between 493 and 1,380 GPs, mainly in rural areas. This is coupled with an ageing population and the likelihood that many GPs will be due to retire by 2026. I understand that the figure for GPs due to retire by 2026 is 700. This paints a stark picture ahead for the rural health service. The emigration rates for young qualified medical graduates, which continue to grow alongside this rapidly ageing population profile, means that unless we get to grips with this emergency now, we are facing catastrophic outcomes in the years and decades ahead.

10 o’clock

We have all seen the recent Irish Independentstudy highlighting the mounting health crisis in rural Ireland, where a severe lack of healthcare accessibility is causing strain on residents and leading to delayed diagnoses and treatments. The study found that over two thirds of GPs are currently not accepting new patients, which signifies shrinking healthcare on the horizon in rural Ireland.

What does that mean in real terms? In the worst-case scenario, it means an early or avoidable death or more intense and prolonged treatment. Those are the facts and what we are talking about here. The lack of GPs in any area and even my own area of Offaly, rural or urban, logically means people who need to be seen quickly for a referral or initial diagnosis are not being seen. This can lead to the development of conditions that might have been addressed more effectively if a GP or doctor had been available to diagnose or assess. From our perspective, all of these issues are being disproportionately felt in rural communities where we live and work.

What is truly alarming is that, looking around the world, the same is true in rural communities almost anywhere. Even in Australia, where so many of our emigrants are and are heading to, we have seen rural GP services and rural medical provision described as a professional wasteland. Indeed, in the UK, the Royal College of Physicians warned that just 13% of consultants appointed in England last year went to hospitals serving mainly rural or coastal areas, with the other 87% being hired by those with mainly urban populations. Examples from other countries could be multiplied with ease.

Coming back to our own country, what this reveals to me is that while Ireland is far from unique, rural communities must be prioritised with the delivery of a rural healthcare strategy that fundamentally addresses these kinds of geographical inequalities. I have no interest in getting up here and simply complaining about this horrendous situation. I want at the very least to point towards some solutions such as those outlined in the Shaping the Future discussion document from the Irish College of General Practitioners, ICGP, last year. In it, the ICGP outlines the ten potential solutions it believes will help relieve the GP workforce crisis, as well as the non-EU rural GP initiative.

What do we need to do? We need to expand GP-led multidisciplinary teams. We need to at least double the number of GP practice nurses, which is key. Many people think they need to see a GP, but a professional practice nurse can take the pressure off GP waiting times. We need to resource the career expectations of future GPs. Local GP roles can be seen as not very exciting or fulfilling from a career perspective, whereas many local GPs who actually take up the role feel that it is at the heart of good medical practice and can be deeply rewarding when properly resourced. We must provide suitable premises for GP-led multidisciplinary teams. We must support suitably qualified GPs to take on General Medical Services, GMS, scheme and medical card lists. We must have increased remote consulting, but this may be more difficult where unreliable broadband unfortunately is still an issue. Many older people still prefer the personal touch. The final point the ICGP gave as a solution was to increase exposure to general practice in medical schools.

These are just some of the many ways and solutions that have been put forward that we can put in place to help to rejuvenate rural GP services. I am aware that the non-EU rural GP initiative is aimed at addressing the issue of brain drain faced by the Irish healthcare sector by attracting non-EU doctors to rural general practice, and that this has led to about 50 participants. That is to be welcomed. The ICGP, as we know, has stated that it wishes to attract at least 100 such doctors to Irish rural practice throughout 2023. While this is welcome to some degree, there appear to be real ethical issues with taking away medical professionals from what may be already poor or underdeveloped areas, particularly when we have a substantial number of our own graduates who could be motivated or incentivised to stay at home and work here.

I accept there are no easy solutions, but at the same time the policies that have been adopted to date unfortunately have failed. There is a myriad of complex and intersecting issues relating to this crisis. Among them is the sheer unattractiveness of living and working in Ireland, with the lack of housing, sky-high rents and an insurance sector that seems almost designed to exploit. All of these things make it more difficult for GPs who are private practitioners to be able to choose a professional life here. The longer these issues prevail, the worse the situation becomes, because existing pressures are then deepened, which in turn leads to professional burnout and to even more pressure on the GPs who are available.

Mention has also been made of the capacity constraints that now exist. We have a Government prioritising free universal access when the capacity of the system to absorb those numbers is just not there. We need targeted supports for the vulnerable in rural and urban communities. What we absolutely do not need are more of the same failed and failing policies, the only outcome of which has been to deepen a GP availability crisis that shows no sign of abating.

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