Joe McHugh (Donegal North East, Fine Gael)
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Question 6: To ask the Minister for Health and Children if, regarding plans of the Health Service Executive to establish 530 primary care teams at 200 sites by 2011, and in view of the moratorium on recruitment, she has received a staff relocation plan from the HSE for the transfer of existing staff from hospitals to the community; if not, when she expects to receive same; the number of contracts signed for the development of primary care centres to date; and if she will make a statement on the matter. [20616/09]

Eamon Gilmore (Dún Laoghaire, Labour)
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Question 74: To ask the Minister for Health and Children the number of primary teams that are fully operational; if initiatives are planned to speed up the process of establishing these teams; and if she will make a statement on the matter. [20461/09]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 6 and 74 together.

The aim of the HSE's transformation programme is to have 530 primary care teams developed by 2011. A total of 110 teams are in place at the moment. The health professionals in these teams are holding clinical team meetings and delivering integrated comprehensive care to patients. The HSE aims to have a further 100 teams in place by the end of 2009. A number of these teams are at varying stages of development. Many have initial team members identified, while some have staff assigned and are holding team development meetings. The remaining 320 teams will be developed over the period up to 2011.

The continued roll out of primary care teams will be achieved primarily by assigning existing professional and other staff working in primary, community and continuing care services to the teams. Each local health office is developing plans to reconfigure existing community clinical and other staff in this way. Over 850 health professionals have already been assigned to primary care teams and a further 2,700 staff have been identified who will work in primary care teams as the extra teams are rolled out.

The moratorium on recruitment and promotion does not apply to allied health professionals such as speech and language therapists, physiotherapists, occupational therapists and social workers. In fact, these will be increased in order to support the delivery of integrated services to groups like the elderly, children at risk and people with a disability. The HSE also intends, as part of its overall transformation programme, to redeploy into community services a significant number of staff from acute hospitals and corporate functions. The steps necessary to give effect to this are currently being finalised.

A programme to lease 200 new primary care centres from the private sector was announced in the budget. Primary care teams are using, and will continue to use, existing HSE buildings and some of the new centres will accommodate more than one primary care team. The HSE board has already approved the commencement of negotiations in 150 locations and contracts are being finalised for 70 of these. The first group of 80 is due to open next year and the full complement is due to open in 2011.

James Reilly (Dublin North, Fine Gael)
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This is where we lose touch with reality. Listening to the answers given so far today one would think all is well with our health service when clearly it is a shambles, as evidenced by this attempt to put in place a virtual service in respect of primary care. The reality is there are very few primary care teams delivering new services to patients. The Minister referred to physiotherapy and speech and language therapy. Practically all of those who qualified as physiotherapists last year are either unemployed, working in McDonalds and in petrol stations or gone abroad.

We are only moving around the cushions on the deckchairs on the Titanic . No new staff are being recruited. No doubt the Minister will be able to point to one or two areas to which new staff have been recruited. How many contracts have been signed this year in respect of the new centres? It is no wonder the Minister can come up hilarious language, such as "commencement of negotiations" given the number of PR gurus working for the HSE and in the Department of Health and Children. We started this process in 2001 and in the middle of 2009 only ten primary care centres have been built. At this rate, it will be the end of the 21st century before all are in place. How many contracts have been signed this year with general practitioners? Does the Minister accept at this rate of progress it will take decades to put in place all the centres, without which we cannot fix the health service? What plans does she have to expedite this process?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am the first to admit that all is not well in the health service. That is the reason we are involved in a massive programme of transformation in terms of how we do things and the way people work. Primary care is about bringing together under a new working arrangement existing health professionals who very often treat the same service users. I recently visited Ballymun health centre, with which I believe the Deputy is familiar, where I heard firsthand from a public health nurse that, as a result of the bringing together of all services in a physical building, she had been able to cut down by about half of one day a week the length of time she spent on the telephone speaking to colleagues, social workers and other professionals. This is about people working differently and together.

The Deputy will be aware - I believe he supported the proposal - that the infrastructure will in the main be provided by the private sector. There have been huge expressions of interest in the investment, which is worth approximately €1.5 billion. The HSE board has approved 150 different locations and contractual arrangements have been put in place in respect of 70 locations. Given this was only announced in the budget last year, it has been incredibly successful. This is not alone about buildings but about existing health professionals working together.

As I stated, we are moving to a situation whereby there will be recruitment this year of key therapists, who are not covered by the moratorium or the voluntary early retirement scheme.

Jan O'Sullivan (Limerick East, Labour)
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We all agree that primary care teams are good. What is at issue is how to achieve them. Perhaps the Minister would drop her ideology for a minute in dealing with this matter. The Minister said it was stated in the budget that the private sector would provide premises and so on. That is not working. I know it is not working. I know of general practitioners who are receiving letters from auctioneers asking if they would like to locate in particular primary care centres.

Last week, the Joint Committee on Health and Children visited an excellent primary care centre in Mitchelstown, County Cork led by general practitioners from Mitchelstown. It provides a number of services and works in co-operation with hospitals in the north Cork area and in Cork city. It is really good. A point made to me during that visit is that this service should be professional rather than developer led and it should be a not for profit service.

I am asking the Minister to ensure a model is set up that works, involves the professionals who deliver health care and works for patients.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy is wrong; the service is not developer-led. Primary care centres cannot go ahead without general practitioner involvement. That is a fact. The Deputy will be aware that many of the successful projects have been promoted by general practitioners. I note a facility involving practically all general practitioners in the Killarney area has just been refused planning permission, which is unfortunate.

Who owns the building is not of concern to me nor, I believe, to patients. The State does not have €1.5 billion to invest over the next couple of years in buildings for primary care teams. I have no problem with general practitioners or general practitioners in conjunction with others, raising money to provide them, as has been done in some cases. The key requirement is to have these teams in place as quickly as possible. As I stated, currently 110 are in place and it is hoped that will increase to 200 by the end of the year. Also, 2,700 people are currently in discussions in relation to working on those teams. These are people currently employed by the public health service.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Enhanced primary care teams have been presented as a way of addressing overcrowding in hospitals and, unbelievably, as a substitute for acute hospital care in the context of the downgrading of local hospitals in areas such as Monaghan, Dundalk, Nenagh, Ennis, Cork and Kerry. How is this enhanced care in the community to be delivered under the embargo on recruitment? From where will these additional frontline health care workers come?

Everyone in the State is entitled to free inpatient hospital care but there is no universal entitlement to primary care services such as public health nurses, physiotherapists, speech and language therapists and so on. How is the Minister going to square that circle? Why is there no provision of psychiatric nursing services on primary care teams? Mental health nurses working in the community provide a different service in that they deal in the main with cases already diagnosed. To give an example, currently in the Monaghan area, owing to the non-replacement of nurses on the community mental health teams, there is a reduced ability to conduct assessments. All health care providers in the community need to be able to refer people about whom they have concerns to a qualified psychiatric nurse who is part of a primary care team. Will the Minister provide psychiatric nurses as an integral part of primary care teams? Currently, no such provision is made. What are the Minister's real plans?

Mary Harney (Dublin Mid West, Progressive Democrats)
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We have, in the past few years, employed an additional 12,000 nurses in the public health system. Deputies will be aware from the OECD report which examined regulation and public sector services in Ireland that we have the highest ratio in the entire OECD. In fact ours is double the ratio in France and is substantially higher than the ratio in Northern Ireland and the UK.

My colleague, the Minister of State, Deputy Moloney, is rolling out A Vision for Change in respect of which I accept there have been some delays. A number of additional mental health teams, in particular in respect of children and adolescents, will be put in place this year. There is a robust debate about who should comprise membership of the primary care team. Pharmacists have made a case for their involvement. Deputies will be aware pharmacies are a commercial enterprise. There are many issues arising in regard to the precise make up of the team. It is important that, within the new primary care centres, the services being provided in a region are provided in one location and that staff treating the same clients or patients do so as part of a team.

Brendan Howlin (Wexford, Labour)
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I will allow a final brief supplementary from Deputy Reilly.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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There is no universal access. How will the Minister square that circle in relation to universal entitlement? These are not alternatives to existing acute hospital services.

Mary Harney (Dublin Mid West, Progressive Democrats)
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We can have a debate about universal access but at a time when we are under pressure to provide services for those who need them most, that is quite a bit away.

The promised eligibility and entitlement legislation is-----

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It has been promised for nine years in the programme for Government.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I accept that. It is major legislation.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is also included in the current programme for Government.

Mary Harney (Dublin Mid West, Progressive Democrats)
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It is incredibly complex legislation in regard to who is entitled to what, an issue on which we need clarity as soon as possible.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister cannot say when it will be published. That is not a response. None of that is a response.

Brendan Howlin (Wexford, Labour)
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I call Deputy Reilly on a brief supplementary question.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I do not think it is very far away given the closure of acute services at Monaghan General Hospital.

Brendan Howlin (Wexford, Labour)
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I call Deputy Reilly.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I understand Deputy Ó Caoláin is to see the new service tomorrow at 11.30 a.m.

Brendan Howlin (Wexford, Labour)
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I have called Deputy Reilly.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I hope the Deputy will go to see it.

Alan Shatter (Dublin South, Fine Gael)
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The Minister will have her spies out.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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That is not an alternative.

James Reilly (Dublin North, Fine Gael)
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I asked the Minister a question earlier which she has not answered. I will ask it again. However, before I do I point out that the new Fine Gael policy, "Fair Care", will provide free GP care, a free medication package and robust community mental health facilities in each of our primary care centres.

Brendan Howlin (Wexford, Labour)
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A question, Deputy, please.

James Reilly (Dublin North, Fine Gael)
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Seo í an cheist. Chuir mé an cheist chéanna cúpla nóiméad ó shin.

Brendan Howlin (Wexford, Labour)
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Go díreach, le do thoil.

James Reilly (Dublin North, Fine Gael)
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How many contracts has the Minister signed with GPs for these new centres in the past 12 months? I do not want to know about the commencement of negotiations, sites identified or virtual primary care teams. I have heard about all of that.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I would like Deputy Reilly to get the independent unit in the Department of Finance to cost his "Fair Care" proposal. It proposes that nobody will pay any more money. Who will pay for this universal access?

James Reilly (Dublin North, Fine Gael)
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We are paying €5,000 a head and in Holland they pay less than €4,000.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The last time the Deputy was involved in universal access, he nearly broke the bank with what we had to pay the doctors.

James Reilly (Dublin North, Fine Gael)
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I am only trying to be helpful to the Minister.

Brendan Howlin (Wexford, Labour)
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Allow the Minister to give a brief final reply.

Mary Harney (Dublin Mid West, Progressive Democrats)
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As the Deputy knows, I am not involved in any negotiations nor would it be appropriate for me to be involved in negotiations.

James Reilly (Dublin North, Fine Gael)
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The Minister does not want to answer.

Mary Harney (Dublin Mid West, Progressive Democrats)
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That is entirely a matter for the procurement service within the HSE. No contract will be signed unless general practitioners are involved as the Deputy knows as well as I do.

James Reilly (Dublin North, Fine Gael)
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For the record of the House only one contract has been signed at the moment despite all the hype and spin that has come from the far side of the House.

Brendan Howlin (Wexford, Labour)
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The tradition is that the Opposition asks the questions and the Government answers them.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Leas Cheann Comhairle should mention that to the Minister. She has not responded once.