Colm Burke (Fine Gael) | Oireachtas source

I move amendment No. 1:

To delete all words after "Seanad Éireann" and substitute the following:"? affirms the Minister?s commitment to the aims of the primary care strategy, which has the key objective of developing services in the community, giving people direct access to integrated multidisciplinary teams of general practitioners, nurses, physiotherapists, occupational therapists and others. The continued development of primary care teams and primary care centres are fundamental to making it easier for people to access care closer to their homes;
? welcomes the infrastructure stimulus package within which primary care facilities will be developed at 20 locations across the country using the public private partnership, PPP, mechanism;
? notes that a number of criteria were used in selecting primary care centres for development by PPP. These included the deprivation index for the catchment population, the service priority identified by each integrated service area-local health office, an accommodation assessment, existing health facilities, GP to population ratio, pressures on services, particularly acute services, funding options and the feasibility of implementing the development as a PPP;
? notes that the HSE is facing a significant challenge in 2012 given the need to set expenditure levels within the parameters of the national recovery plan;
? acknowledges the significant reductions which the health sector has experienced over the last three years, both budgetary and staffing;
? notes that the HSE has operated the Croke Park agreement very effectively, with over 3,500 staff redeployed, and a reduction in overall numbers of over 6,000;
? commends the Minister for Health on managing within this difficult environment, and at the same time achieving cost reductions within the health sector which are impressive by international standards, particularly within the hospital sector;
? supports accelerating the type of service delivery reforms that will move to models of care across all service-care groups which treat patients at the lowest level of complexity and provide services at the best possible unit cost; and
? welcomes the Minister and Government?s determination to move towards a health system that provides access based on need rather than income, underpinned by a strengthened primary care sector, a restructured hospital sector and a more transparent "money follows the patient" system of funding that will be supported ultimately by universal health insurance.".

I welcome the Minister back to the House. He has had a long evening here and we appreciate the time given to this matter. The amendment clearly sets out support for the Minister in the work he is doing. It is important for us to consider the overall goal of what we are trying to achieve in reforming the health service. The last part of the amendment states that the Seanad: "welcomes the Minister and Government?s determination to move towards a health system that provides access based on need rather than income, underpinned by a strengthened primary care sector, a restructured hospital sector and a more transparent "money follows the patient" system of funding that will be supported ultimately by universal health insurance".

We made it quite clear when we came into Government that the introduction of universal health care would take a number of years, and there is a process that must be gone through in implementing it. There is a step-by-step approach, with one such step being primary care units. On 17 July, the Minister for Public Expenditure and Reform, Deputy Howlin, announced an infrastructure package of ¤2.25 billion, with ¤115 million allocated to two bundles of primary care. Initially, the idea was for 20 primary care units identified that could be developed, and another 15 were added. I wonder how the other side of the House would have reacted if the Minister announced today that there would not be an additional 15 units? How would the people who will benefit from the additional 15 units feel towards the Opposition if they were suddenly withdrawn? That seems to what the Opposition wants but the Minister is not prepared to do it. He wants to use the money and the opportunity available to him to develop primary care units in the maximum number of areas in the fastest possible time.

The criteria are quite clearly set out, with a number of issues taken into account. For example, elements include the deprivation index, the service priority identified by each integrated service area, the accommodation assessment and staff surveys. Additional criteria include competition, GP co-operation and the population being served by general practitioners. Pressure on services, particularly acute services, have been taken into account, as well as funding options such as Exchequer funding, builder lease and implementing public private partnerships. All these elements have been taken into account when the Minister has considered primary care.

My colleague across the House asked why we do not examine the potential use of unoccupied buildings. In constructing a health care centre, certain standards must be reached, and not every building can be adapted to cater for health care. In many cases it is probably cheaper to construct a brand new building than adapt an existing building. We must consider such issues. We have identified 35 areas where primary care units can go ahead, but we must go through a process, and they will not suddenly appear overnight. The locations have been identified but the type of building required, for example, must be determined. We must make progress.

On Monday there was a letter in the Irish Examiner arguing that there has not been a health care sector in Ireland for decades. We now appear to have gone down the road of hysteria, with people convinced there is no health care sector in place. I can give out figures repeatedly. In fairness to previous Ministers, much development has taken place in the health care sector over the past ten, 15 or 20 years, although we could have done more. We must get on with the process at this stage. The fear being put into people's minds is a concern because people are very worried.

I had a group of people in the House today who raised a number of issues on health care and they did so as a result of the amount of media attention these issues have been given and because the problems have been over-exaggerated.

I will cite some examples I gave earlier. In regard to maternity care, the number of deliveries a year has increased from 55,000 to 74,000. We have the lowest perinatal mortality rate. Outpatient attendances have increased from 2 million to 3.5 million. Some 31,700 people per working day attend for outpatient consultation, even at a time when money is scarce the number of people with medical cards has increased from 1.146 million to 1.8 million. Some 130,000 people have a GP-only card.