Marie Sherlock (Dublin Central, Labour) | Oireachtas source

I wish the Minister and the Minister of State well in their new roles. I think I said to them that they have the shortest titles but probably the biggest responsibilities in the Government.

I join others in saying that we need the Minister and the Ministers of State to do well. For our part, we will do everything to try to support the work they are doing to get the positive health outcomes that we need in this country.

The list is endless in terms of what we could say when talking about longer, healthier lives but I am conscious that those advocating on behalf of people who suffer from rare diseases were in Leinster House today. What is critical for them is support for research and, crucially, access to new drugs in the market. Daffodil day is just a month away. The Irish Cancer Society has made a particular call to reinstate the Laura Brennan catch-up scheme for HPV vaccination, which expired at the end of January 2024. I ask the Minister to please try to do that. As she said in her comments, small things can make a big difference and impact on people's lives. The HPV vaccination has proven to have a big impact to people's lives and we must continue with the catch-up programme.

The issue I want to talk a little about this evening concerns primary care. We have a twin issue in Ireland of a growing life expectancy and an ageing population. Perhaps the single greatest challenge for the Minister is ensuring that we have a primary care system of supports that is both fit for purpose and sufficiently equipped to respond. Average life expectancy is now fifth highest in the EU at 82.6 years. We know that the share of over-65 year olds is expected to grow by almost 24% by 2044. We also know that age is not the clear-cut determinant of health need, rather it is the proximity to death and the incidence of morbidities among the population. Therefore, it is not about life expectancy but a healthy life expectancy. As I understand it, the reality is that in this country that is going down rather than up - from 69.6 years in 2019 to 66 years in 2022.

When we throw economic circumstances and the level of deprivation into the picture, we begin to get a much more stark situation. In 2024, Pobal research into disability and deprivation found the people in the most disadvantaged areas are four and half times more likely to report not having good health than those in affluent areas. Furthermore, it goes on to say that people living in disadvantage areas are twice as likely to have a disability compared with those living in affluent areas.

In my constituency in Dublin Central, research conducted by the HSE profiling the north side of Dublin and based on the 2022 census found that the numbers reporting good health was just 38.3% - more than a third of all people. The national average is 53.2%.

How is the State responding? Let us take GP care. This is the first point of contact for almost all persons seeking healthcare in this country. We have a private system of primary care and a public system of hospital care. There are no GP to patient ratios. There is nothing to say we should have GP practices in every community in our country. Instead, the State has outsourced the first point of contact in our health system to a private system of GP carers. That is not to say we do not have brilliant GPs, but the reality is that it is a for-profit model, and there are significant implications in that regard for who gets care.

When we look at certain areas, especially in my constituency in Dublin Central, the reality is that we do not have enough GPs. We do not have enough GPs across the country, but especially in the most deprived areas. In Dublin 1, for instance, we have nine GPs on the GMS scheme. In Dublin 7 there are 17. Finglas, if anybody knows it, is typically divided into two - Finglas east and Finglas west. The west has far higher levels of deprivation. There are 14 GPs in Finglas east but there is not a single GP in Finglas west. How can the Department of Health stand over this? There are significant questions about inequality of access to timely healthcare in certain communities.

I wish to raise the situation of a GP practice in Dublin Central - the Summerhill Family Practice - GP Care For All. I hope the Minister is familiar with the situation. It is in operation since 2016. It is a charity model operating in an area that is crying out for GP care. Since February last year that practice has been put in jeopardy because of a change to the Finance (No. 2) Act 2023, which changed section 1008A of the Taxes Consolidation Act 1997. The change effectively precludes the practice from operating as a charity. This charity practice that provides services has a list of 2,600 patients. It has the funding in the bank to extend the practice list by a further 1,200 to 1,500. It has more funding again to set up a practice in Finglas west, but it cannot do anything at the moment because of the limbo it finds itself in because of the tax changes to the finance Act last year. It is crucial to say that nobody is beating down the door to start a GP practice in the north inner city. Almost all the patients in this practice are on the GP scheme so there is no incentive or profit in this practice.

I ask the Minister to look at the weighting for GMS patients, which prioritises or weights in particular women of childbearing age and older patients. However, when we look at the typical profile of people attending the practice in Summerhill in Dublin 1, the life expectancy is much lower. The practice tells me it does not have patients in their late 60s, 70s or 80s, and there is a reason for that. Twelve months on from discovering the change to the finance Act that is putting this vitally important GP practice in jeopardy, and after many letters going to the HSE, the Department of Health and the Department of Finance, there has yet to be a face-to-face meeting between the Minister for Health and a serving Minister for Finance. I ask the Minister to change that. More crucially, I ask her to personally intervene to ensure that this GP practice survives, because if we were without it, it would make a mockery of our discussion about healthy lives.

To add to the farce, the HSE has had to come in to provide funding to an accountancy practice to try to put forward a solution to how the finance Act might be amended. It is also providing funding to the double PAYE payment that is going to become liable by the end of this year. It is a complete waste of money in the general scheme of things, and that needs to change.

Ultimately, there is a wider question here about the future of GP care in this country. A charity was set up because it is impossible to get GPs to set up a practice. When I talk to trainees they tell me they want to be clinicians; they do not want to set up a business. Cracking the nut of having more GPs in this country must be about direct employment.

If we are serious about primary care, then we must look at home care packages. Deputy Cullinane is correct in what he said about a statutory right to home care. At the moment we have an utterly haphazard system that has grown up in a bizarre way. I remember talking to a woman in her 70s a number of months ago, who spoke about the absolute torture of trying to get help for her husband. She had to speak to five or six different providers in the area. The public health nurse was helpful but could not provide her with all the oversight or detail she needed to try to care for her husband in the home. She is saving the State an enormous amount of money, yet there was no single point of contact. As there is no statutory right to a home care package, the reality is that we have an utterly haphazard system.

In the remaining minute and a half of my time I wish to pick up on what Deputy Conway-Walsh spoke about. I too met the Cared Ireland organisation today, which presented on eating disorders. The expansion of community hubs is very welcome, but anybody who understands eating disorders in this country knows that it is a matter of life or death. It is not a minor health issue that can be just treated in the community. The reality is that this country has outsourced inpatient care to charities and private providers. Some 76 admissions for eating disorders in this country were to charities and private providers. The vast majority have to go to England. A woman talked today about a child, who is now an adult, being an inpatient in Britain for seven years, who cannot leave yet because she is not fully treated. We know from the Health Research Board that those with an eating disorder have the longest inpatient stays of all psychiatric illnesses, yet we have a Minister of State who says there is no need for additional inpatient beds in this country. It is not either of the two Ministers present in the Chamber, it is the other Minister of State. There is a need. I ask the Minister to change that. There is a commitment to 20 beds since 2018.

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