Wednesday, 22 June 2016
Primary Care Centres
I welcome the Minister of State, Deputy Canney. I believe this is his first time here. I wish him every success with his portfolio. Senator Leyden has four minutes to address his issues and then the Minister of State will respond, after which we might allow a brief supplementary question and answer.
I welcome the Minister of State, Deputy Canney, and congratulate him on his appointment. In his first term as a Member of Dáil Éireann he is a Minister of State as well, which is a fair achievement, following his fellow Tuam man, the Minister of State, Deputy Finian McGrath, who has just gone out the door. Tuam is certainly on the map at the moment.
There has been speculation that the primary care centre in Monksland in south County Roscommon could be moved from the Galway, Mayo and Roscommon community health organisation, CHO, area 2, to CHO area 8, which covers Laois, Offaly, Longford, Westmeath, Louth and Meath. This is a different province. Roscommon has no political mandate on the HSE in the CHO area 8. The councillors in Roscommon, Paddy Kilduff, Tony Ward and Laurence Fallon are involved on HSE west. A decision to move Roscommon to CHO area 8 would create a democratic deficit and take away the voice of the people of Roscommon in their health affairs.
The HSE has advised that it is currently reviewing how community services can be best delivered locally to communities in an integrated way. It is not in the best interests of the people of south County Roscommon who have their primary needs looked after in south Roscommon in the purpose-build HSE west primary care centre. To move it into another administrative district may make sense to faceless bureaucrats who want to tear Roscommon apart at every opportunity - the save Roscommon campaign continues to seek to stop the proposed boundary review commission changes. This does not make sense to the people in south County Roscommon who want a health service in their locality. I also seek the Minister of State's support in ensuring that Roscommon is not divided. It is a form of apartheid to take a progressive region away from Roscommon and move it into Westmeath. It is an outrageous proposal and I hope the Minister of State, through his involvement in government, will ensure that does not happen.
The whole ethos of primary care is that it be local health care. Primary care comprises all the health and social services in the community outside hospital. It includes GPs, public health nurses and a range of other services and provides a single point of contact to the health system. There has been significant investment in this centre at Monksland. Services have been centralised from throughout Roscommon to this primary care centre at Monksland. While it may be speculation, sometimes speculation becomes reality. Along with all other Oireachtas Members from the Roscommon-Galway constituency I was approached about this issue and it is only right that I should put it before the House and seek a response from the Government.
I thank Senator Leyden for his kind words and welcome to this Chamber. I thank him for raising this issue. I am taking the debate on behalf of the Minister, Deputy Harris, who is elsewhere on Government business.
The development of an enhanced primary care system and guaranteeing the future sustainability of GP practices in rural and disadvantaged urban areas are priorities under the programme for Government and an important element in the health reform process. Our ultimate goal is to ensure that people get the care they need as close to home as possible and that they have access to a greater range of health and social care services in their communities.
Following the decision in 2013 to organise the country’s acute hospitals into a number of hospital groups, the HSE was requested to review the structures then in place for the delivery of non-acute services. A thorough review was commenced in 2013 and completed in 2014. This examined international experience regarding the implementation of integrated health and social care, with a particular focus on achieving successful integration. The review also involved consultation with providers and users of health services, as well as the public services including the local authority, education and justice systems.
The review rigorously evaluated options, taking into account the requirement for appropriate care pathways between primary care and acute services, the planned hospital groups and local authority boundaries. It also focused on what would benefit the provision of integrated care to the general population and support the implementation of Government policy on the care of older people, people with disabilities and those in need of mental health services. The review concluded that achieving integrated care means that services must be planned and delivered with patients' needs and wishes as the organising principle and that integrated care can make a real difference to the quality of care and hence patient outcomes. After a careful evaluation of options, the recommended approach was to restructure the 17 integrated service areas into nine community health care organisations, CHOs.
The HSE has, since 2014, been proceeding with a detailed implementation plan which positions primary care at the centre of delivering services and will see the establishment of around 90 primary care networks of health and social care professionals, each serving a common population of approximately 50,000 people.
It is very important to stress that, from the point of view of people using the wide range of services provided by the HSE at community level, the management structures which overlay these should be of little or no consequence. The objective is to ensure that services are responsive to people’s needs and enable them to receive a joined-up service that results in the most favourable health outcomes for patients. The HSE has indicated that the Monksland primary care centre is currently located in CHO area 2, which covers Mayo, Galway and Roscommon and that no decision has been made to transfer this centre to CHO area 8.
I understand that four GPs are based in the centre and that other services based there include public health nursing, physiotherapy, occupational therapy, speech and language therapy, social work, psychology and mental health services. Other services use the centre for clinics. This is very much in line with the policy of Government whereby we want people to be able to access the majority of their health care needs in the community, and as far as possible in one location. I trust this clarifies the matter for the Senator.
I welcome the Minister of State's statement that the HSE has indicated that the Monksland primary care centre is currently located in CHO area 2 and that no decision has been made to transfer this centre to CHO area 8. The Government should take more control. Ministers should decide on any major transfers. I would have much more faith in dealing with the Minister of State, Deputy Canney, the Minister, Deputy Harris, the Taoiseach or any member of the Government than dealing with the HSE. I hope the Government will take back control of the health services from the HSE and become more hands-on regarding all decisions being made.