Billy Kelleher (Cork North Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

To ask the Minister for Health the reason that two primary care centres in Swords and Balbriggan, County Dublin were added to the list of 35 primary care centres published by the Health Service Executive in July; the person who made the decision to add these two centres; the criteria for adding them and if different criteria was used compared to the criteria used for the original 20 on the list; and if he will make a statement on the matter. [41082/12]

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Early in 2012 the HSE embarked on a prioritisation exercise for primary care, PC, centres across the country. It is the intention of the Government to develop as many centres as possible by one of three separate methods: direct investment; by way of leasing arrangements; or by way of public private partnership. The locations were then considered for development by way of PPP as part of the Government's stimulus package. Selecting the primary care centres under PPP was not - as is generally believed - done on the basis of one criterion, the deprivation index. Three criteria were deployed: the deprivation index for the catchment population of the centre; the service priority identified by each integrated service area-local health office; and an accommodation assessment which assessed accommodation available for the primary care team within the catchment area, the quality of the accommodation, and whether it was spread over more than one building.

The HSE in this new process identified 338 locations for PC centres. From this, 20 were selected on the basis of accommodation availability in the locale, service priorities, and deprivation. A total of 37 locations within the list of 338 had a similar ranking. I accepted the first list of 20 prospective centres presented by the then Minister of State, Deputy Shortall. However, I decided - in consultation with my Department officials and ministerial colleagues - to go beyond the initial mathematical model on the basis that the number was too small and that we needed at least 35 centres. Advice from the HSE and the Department of Health based on experience of PPPs is that if only 20 were pursued considerable slippage could arise and the health system could lose a badly needed investment. I also took into the account that the track record of the HSE in delivering PCs on time is poor. In addition, the available €115 million stimulus fund could only be accessed by means of PPP.

As I wrote to the then Minister of State, Deputy Shortall, on the 25 July, "A very strong consensus emerged at Government level that identifying 35 locations would stimulate and encourage wider interest and participation...". In other words, if we were to identify only 20, and stick with 20, GPs would then be able to sit back, await their completion and then enter on their terms only. If one looks at what happened in an urban area where a primary care centre was built, the process began four years ago with pre-contract discussions with local GPs, the building was completed in 2012, but it took several months to get the GPs to move in. A similar situation arose in a rural area. Therefore, the list was widened. In addition, new criteria were added. It was evident, for example, that consideration needed to be given to existing health facilities; GP to population ratio; pressures on services, particularly acute services; funding options, including Exchequer-funded, HSE build or lease; and the implementability of a PPP in terms of size, site and scale.

The criterion of existing health facilities was added because if they were not considered one could possibly have a health centre built in the shadow of an acute hospital, while a nearby area of great need would be left without a primary care centre, which would make little sense.

Under these wider criteria, 15 additions were made to the list, some of which had been identified as high priority by the HSE as far back as 2007, under a Fianna Fáil Government. However, because of the weighting I mentioned - namely, the multiplication of the deprivation index by three - two of the areas that had been identified in 2007, Balbriggan and Swords, lost out and were swept from high priority to low priority. Under the original priority system both would have been in the top 35 but under the new system, with an altered weighting system, they ended down the list. The realities had not changed but the weighting made it look as if they had.

Balbriggan is an area of high unemployment, with no existing primary care centre, whose current health centre is in a very poor state. It will proceed under a lease arrangement. Swords has a population of 48,000, no primary care centre and no direct public transport link to its nearest hospital, Beaumont Hospital. There can be no doubt that these two areas are high priority for primary care centres. It is my intention to further primary care developments as resources become available.

Billy Kelleher (Cork North Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Minister for his reply. Two weeks ago, the then Minister of State, Deputy Shortall, made a statement in the Dáil. There were two items of interest in that statement, one being the omission of any support for the Minister in the motion of confidence he faced. She did not mention the Minister for Health by name or by office in any part of her contribution. The other key issue of interest was the former Minister of State's statement that the public had a right to expect decisions on health to have a structure and that staffing decisions would be made in the public interest and based on health need and would not be driven by other concerns.

There are clearly other concerns at stake here. Originally, 20 primary care centres were selected according to the deprivation index. The Minister subsequently stated that others should be added to ensure that GPs could not hold the process to ransom. I can understand that. The most obvious scenario, however, would have been to take the next 15 choices on the list, if the Minister were to proceed with the 20 high-priority projects that had been selected according to the deprivation index. However, halfway through he changed the criteria to allow others be included.

Public private partnerships confer commercial advantage. The State enters into a contract with individuals or an entity and this confers a commercial advantage on them.

Michael Kitt (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Please frame a question.

Billy Kelleher (Cork North Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Would the Minister not agree that to do that there must be a transparent and open process that should be free from any form of interference, even alleged interference? I wondered at the time why a Minister of State would come into the Chamber, stand up and state that she had concerns and that the public had a right to ensure the process was carried out in an open and transparent manner, without any other concerns.

Michael Kitt (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Thank you.

Billy Kelleher (Cork North Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Ultimately, four centres were identified, two of which were in the Minister's constituency, one in Kilkenny and one in Ballaghaderreen. What type of criteria were used? Did the Minister run this by his Cabinet colleagues? Some of those colleagues stated clearly that he had not. The Minister for Transport, Tourism and Sport, Deputy Varadkar, said recently on television that this could be constructed to look like stroke politics. He was unaware of any consultation. Was an aide-memoire or memo sent to Government? How did the Minister consult with his colleagues? Was this done one night somewhere in the corridors? This needs to be clarified once and for all.

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I agree absolutely that primary care centres should be chosen on the basis of need. The widening of the criteria helped to meet those needs in a much more complete manner. That manner and those criteria are transparent and I have outlined them to the Deputy today. I also indicated that as long ago as 2007, when his Government was in power - which is purely coincidental - the HSE identified the two towns of Balbriggan and Swords as being high-priority and in need of centres. That was more than five years ago. Since then the population of both towns has increased, employment has increased and the needs of the people could not be described as having diminished. They are greater than they were.

I reiterate that I stand over both the manner in which this was done and the criteria I used, and I will be happy to explain whatever aspect of this matter the Deputy fails to understand.

Billy Kelleher (Cork North Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I am not the only one who fails to understand this; the former Minister of State with special responsibility for primary care and some of the Minister's Cabinet colleagues also failed to understand it. It is not that Billy Kelleher is the only person in this House who cannot understand the criteria the Minister decided to use to select certain sites for primary care centres that were outside the matrix that was used previously - that is, the deprivation index. If the deprivation index is used to select 20 high-priority centres and then, all of a sudden, the entire set of criteria changes to include factors such as population and locations of other health centres, the process is undermined from start to finish. If the first 20 centres are chosen based on one index and the others are based on the Minister's own index, clearly the Minister has not prioritised the key factors as outlined in the original index.

It is not that I am trying to find anything untoward, but it is quite evident that there was not a transparent and open process in the awarding of commercial advantage to individuals by the State. That is of major concern to many people, including the former Minister of State, Deputy Róisín Shortall, who resigned because of it. Does the Minister agree that this issue does not sit well with many people, other than me, on this side of the House?

James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I have no wish to enter into argy-bargy with the Deputy opposite and I know that is not the tenor of his comments. However, I must point out that in my initial answer I stated that the deprivation index was but one of three criteria used in this process. There were also the service priority as identified by each integrated service area or local health office, and an accommodation assessment. These are three criteria that were used. What happened then was that the deprivation index was given a weighting, or multiplication, of three, which resulted in a considerable change in the prioritisation.

I put it to the Deputy that by broadening the criteria to take into account the issues I have mentioned to him - namely, the availability of or lack of health facilities in the area, accessibility to those facilities by way of public transport and the population-to-GP ratio - one gets a much wider and, in my view, fairer balance. If we were to use only the deprivation index it would have a very strange effect. In fairness to the then Minister of State, now Deputy Shortall, she did not do this but used two other criteria. I used additional criteria which I believe are also fair. In the Minister of State's resignation statement this issue is not mentioned per se.

I wish to put on record, if I may, my gratitude to the Minister of State, Deputy Shortall, for the hard work she did and the commitment she had to primary care, a commitment I share. I welcome the nomination of Deputy Alex White to the Department of Health. I know he will continue the work done by the former Minister of State - particularly, I hope, the great work she did in regard to alcohol, that scourge of a problem we have in this country. I hope her work in this area will be carried on by the new Minister of State, Deputy White. I have no doubt he will be as committed to the full range of issues as Deputy Shortall was.