James Reilly (Fine Gael) | Oireachtas source

I welcome the Minister of State and his officials. I also welcome the fact that there has been an increase in the health budget this year, after several years of increases. That is truly welcome because for many a year when I was Minister for Health all we had was a diminishing budget. Health is such a huge area that it is not possible in five minutes to address it comprehensively in any real way so I will focus on an area that is on people's minds, namely, primary care and community. It is of note that in a recent survey by Professor Tom O'Dowd mental health services were top of the list for 1,000 people interviewed. That is a very important area. On-site X-rays were next, followed by minor surgery, blood tests and lifestyle advice. I will come back to that last point because I often said when I was Minister for Health that I felt I was Minister for ill-health as we seemed to talk only about illness and disease, instead of about keeping people well, prevention and early intervention.

Reform remains key and capacity in our hospitals is an issue but we need a transitional fund if we are going to move the focus from hospital care to primary care. I welcome Tony O'Brien's comments in this regard. If we do not have that we cannot achieve it. Any time we want to change things it requires energy and resources. We did not have the money in the past to do that but we do now and I welcome the fact that this is acknowledged in the ten-year Sláintecare report. I firmly believe that we need to treat patients at the lowest level of complexity that is safe, timely and as near to home as possible, and affordable for the patient. I see that echoed in the report and welcome it.

In his report on primary care, Professor O'Dowd also says that the secret sauce at the centre of successful outcomes for patients is regular contact with a good and caring doctor. That brings me back to the old definition of general practice, which still holds true for me, namely, primary, personal continuing care. The two words in the middle are very important, "personal" and "continuing", that patients go to the same doctor who know them and their history, so that particularly in respect of mental health issues they do not have to open up to somebody new and go through their whole story again.I have met many patients who have been frustrated by this and cease going to their clinic because there is a different doctor there every time they go and they do not have the energy to go through it all again, whereas meeting somebody on an ongoing basis who can help to manage a patient's condition, knows his or her story, family and community is very valuable for him or her.

As everybody understands, we need a new GP contract. I heard Senator Keith Swanick mention the FEMPI legislation. This will be a sore point for many doctors because while we had to take these measures during the financial emergency, they see many sectors coming out of it but do not see any progress at their end. That will be a problem. That aside, a new contract needs to focus on well-being and health. I again refer to the survey of lifestyle advice about keeping people well.

We also badly need more day hospitals. The Minister of State is familiar with the hospital in Bantry which is in his neck of the woods. There are are Nenagh, Ennis and Louth county hospitals. We need more day hospitals in Dublin where patients can undergo inpatient procedures for a hernia, gall bladder, etc. We need one in Swords which would be convenient for people living on the north side of the city who would come out against the traffic. It will allow Beaumont and the Mater hospitals to run outpatients' clinics which would be much more convenient for patients. In the new primary care centre in Balbriggan which is up and running we need diagnostics. Patients want to access X-ray facilities. It is included in the survey but doctors know it. There is nothing new in this. In County Donegal where a high value has always been placed on primary care services because of the geographical spread of services, there were X-ray facilities in four areas. There was one in Killybegs, but I cannot remember the others now. I heard Senator Keith Swanick talk about one in Belmullet. That is the way forward. We cannot keep doing the same things in the same way. Reform is key.

We need to expand primary care teams with more allied health care professionals. When I had a physiotherapist in my practice, instead of reaching for the prescription pad to prescribe a non-steroidal anti-inflammatory, I reached for the pad to refer a patient to the physiotherapist and the outcomes were better. If we have these facilities in the community, we would keep people well. It is never as sexy politically or as attractive for politicians to be involved in good public health policy as it is to launch a new MRI scanner or a new hospital wing, but we have to focus on public health policy. I welcome the tobacco and alcohol control Bills and the sugar tax, but we need joined-up thinking across the board. From the point of view of the health budget, we need this transitional fund to make these changes happen because acutely ill patients take precedence, rightly so, but if we keep doing this, we will never address the flow into hospitals.