Duncan Smith (Dublin Fingal, Labour) | Oireachtas source

11 o’clock

I also want to extend my sympathies and those of the Labour Party to Deputy Collins on his loss. I thank the Rural Independent Group for bringing forward this motion on GP numbers and rural healthcare.

I will send the Minister of State a note on this, but there is a situation with a community nursing home in Nenagh that has been in development for seven years. My colleague Deputy Kelly has been instrumental in pushing this forward. The facility has been built and is ready to go. The Deputy received a communication from the HSE stating that it is not in a position to say when the home will be open or what the timeline in that regard is. This is because it cannot provide the whole-time equivalent staff who are needed there. This is what the recruitment freeze is doing. Also in Nenagh, St. Conlon's Community Nursing Unit is not going to meet the new HIQA standards. We have a community healthcare facility ready to go that we cannot get staff.

There is a crisis in the provision of healthcare services in rural and, indeed, all other communities, including my own. The previous speaker mentioned not having enough primary healthcare centres in Kerry. We do not have a primary healthcare centre in Swords, which is the largest town in Ireland that does not have such a centre. I was on the radio this morning making the point that it is the largest town in Ireland that does not have a rail link. We are at the top of a few lists that we do not want to be at the top of. It is incredible that we do not have these services. Like other places throughout the country, we have problems in relation to GP services. GPs are often people's first point of contact with the wider health service. For many years, they have been a cornerstone in towns, villages, communities and cities all over the country. Many families will have had the same GP for decades. It is not unusual for a GP to take care of multiple generations of the same family. For many people, GPs feel like an extension of the family. They are a constant and someone they trust who provides them with a positive and trusted gateway into the wider health service. This is people are so concerned by the fact that they cannot get access to GP services. Even when they do, they face a long wait. According to a survey carried out for the Irish Independent, two out of three GPs in rural Ireland are not taking on new patients. Some have waiting times of more than two weeks for appointments. While some people in Dublin can get same-day appointments, there are others, including in my constituency of Fingal, who also have to wait for up to two weeks to be seen.

There are irregularities in the context access to care across the country. This needs to change. There can be no postcode lottery when it comes to access to health services. The Irish Medical Organisation, IMO, has outlined that we have seven GPs to every 10,000 people at present. This is despite the fact that we need at least 12 per 10,000 to ensure a safe and effective service. This is another metric in respect of which we are failing. The people of Ireland are rightly angered by this. Rural communities have been especially impacted. Many people have been served successfully for many years by GPs with small practices who are now retiring. It is expected that 700 GPs will retire by 2026. A critical situation is developing rapidly before our eyes. We need to see action in respect of it now.

The Government has facilitated more training places for GPs, but it will take years to see the results of this. There is no guarantee that these GPs will be able to set up services. The statistics we have in respect of young medical professionals here moving abroad are a cause for extreme concern. They speak to what feels like an overall collapse of the system. In 2022 alone, 442 Irish doctors were issued temporary work visas for Australia. Questions need to be asked about how attractive we are making the healthcare sector to our young healthcare professionals. The Government needs to take responsibility for this. All young workers hear about chronic understaffing in our health service, which is worsened by the recruitment freeze in the HSE, as I just outlined with the examples relating to Nenagh. Understandably, workers do not see working in the Irish healthcare system as a viable or prosperous career path. When we couple that with the guarantees they receive when moving abroad about safe staffing levels, decent salaries, better weather and a better quality of life, it is understandable, albeit very sad and lamentable, that so many of our young medical professionals travel abroad.

In 2022, the Irish College of General Practitioners, ICGP, reiterated its consistent call for a working group on future general practice to plan for serious GP workforce pressures in a submission made to the Joint Committee on Health. The ICGP knows better than anyone just how of much of a tipping point GP care is at in this country. According to its statistics, we will need an estimated 2,000 GPs over the next decade in order to meet impending retirements and population growth. This is a massive jump. Without serious intervention and a proper plan, we have no chance of meeting that challenge.

I take this opportunity to highlight an initiative started by the ICGP last year. This initiative aims to attract at least 100 qualified doctors from overseas to rural practices as part of a two-year supervised work programme. At the end of it, the plan is that they will be fully qualified as GPs in the Irish system, that they will stay in their new communities, if they want to do so, and that they will hopefully want to treat publicly funded patients in practices of their own. This is a fantastic initiative. The impact of the GPs who have travelled from all over the world to help the people in this country, particularly those in rural Ireland, cannot be understated. This story was covered by The Irish Times, and those who did make the move to rural communities commented on how they felt the desire to help those they felt had been neglected by a service that was under pressure. Dr. Omair Latif Naz who moved to Clonaslee village in County Laois noted that the welcome they received was superb. This only further supported his desire to stay and help the community. He said, "They’re lovely people and they need us". He also said that people do not want to drive 30 km or 40 km to go to hospital if they have someone they can walk to see in the village.

It is worth noting the positive impact of initiatives to attract overseas workers into rural Ireland. It behoves all Deputies, when we are talking about immigrant workers, to remember the positives they bring to all our communities, including those in rural areas. The example to which I refer is one of many. We know that immigrant workers are the glue that keeps our health service together, not just in our major acute hospitals but also in our rural services. I would like to see that level of understanding and acknowledgement in all debates when it comes to immigration.

Ultimately, we need to see changes and we need to see them now. However, these changes have to be sustainable for GPs in the areas to which I refer. We can no longer expect GPs to forgo holidays, sick leave or time off in order to try to keep up with the growing demands of the local population. Support needs to be provided by the Government in order that GP practices in all communities, including those in rural areas, can grow and be an attractive option for young workers to want to join and thereby be part of that element of our healthcare sector.

A record health budget, by the Government's own measure and which it is so fond of mentioning, is no good for the people who simply do not have access to the most basic services. There is no more basic a service in the Irish healthcare system than having access to a GP

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