As these two items relate to medical services in Balbriggan, they will be taken together. Each Deputy will have five minutes.
Adjournment Debate. - Medical Services.
Ba mhaith liom buíochas a ghabháil leatsa as ucht cead a thabhairt dom an ceist tábhachtach seo a ordú inniú.
This debate arises from a large public meeting which Deputy Ryan, myself and other public representatives attended in Balbriggan last Monday organised in the town hall by Balbriggan town commissioners and chaired by the cathaoirleach, Therese Fingleton. Over 500 people attended the meeting and many spoke passionately about their concerns in relation to a service to be provided by general practitioners in the town as part of a doctors on call north-east arrangement between other general practitioners.
This town of over 9,000 is set to grow, depending on one's predictions and the various development plans, to between 35,000 and 40,000 and one would expect an improved and increased level of medical service with perhaps a hospital in the pipeline, which is needed. Instead, we have a curtailment of medical services in that previously there was an evening surgery and a sense that Balbriggan had a publicly available, well run and responsive medical practice in the medical centre, even though it was run by private practitioners. There is now a strong feeling that this service is controlled from Drogheda and is not as available to the people in the area.
Those concerns are made worse by the fact that it is covering two health board areas, unlike other examples such as that in Carlow where one health board area is involved. That highlights additional concerns in relation to ambulance calls, for instance, because different health boards are responsible for different areas, whether it be in Ardee, Clogherhead, Collen, Balbriggan or Drogheda. The Minister has to intervene before this type of private practice arrangement begins to offer an inadequate service for the needs of people, particularly those who are terminally ill, the young, the elderly or people with disabilities.
Concern about this matter was made a lot worse by the fact that a general notice was not issued, other than in the local newspaper, until after the service was introduced. The fact that the price of the treatment is to increase is another cause of concern. People will now be more inclined to go to accident and emergency departments in hospitals and that should be of concern to the Minister, given the drive to encourage people to go to their GPs rather than to hospital. In addition, many people without transport are in a constant state of stress because they are being told that if they need urgent treatment, they should first go to Drogheda before some other arrangement is made. That is increasing the stress, aside from the various medical problems that might need to be addressed. Concern has been expressed also that absenteeism will increase owing to the fact that the surgery in Balbriggan will only be open during office hours.
In view of all of the concerns expressed at that meeting there is an urgent need for the Minister of State and the Minister to intervene before this type of arrangement becomes infamous in the sense that it appears to be a case of the doctors trying to improve quality of life in their own circumstances. The result is that there is a great lack of confidence in the ability of the medical services to respond to emergencies. The elderly in particularly are often reluctant to call a doctor and this new distance between the doctor and the patient, both perceived and real, is an added disadvantage to people who are already feeling disadvantaged. The examples given of delays in response need to be addressed and we need to have some quality control on the kind of medical service being provided.
These arrangements should remain in the one health board area. They should be kept local and accessible and there be compulsory notification of the population which they serve before any changes are brought about. There should also be some type of cap on the price of treatment to ensure that people who do not have medical cards are able to afford these services.
I thank you, a Leas-Cheann Comhairle, and the Ceann Comhairle for affording me the opportunity to raise this issue. On Monday evening last, over 500 people squeezed into the town hall in Balbriggan to express their fears and objections to the new out of hours family doctor service which came into practice in Balbriggan on 18 September. An invitation went out from the Balbriggan Town Commission, which organised the meeting, to the doctors and officials of the two health boards to attend. None of them turned up and I believe this was a public relations disaster, particularly for the doctors.
It should be stated, however, that all the people who spoke at the meeting recognised the excellent service provided by their family doctors in Balbriggan over the years. Time and again at the meeting we heard examples of older people who in the past were able to pick up the phone and talk to their family doctor. The fact that this was going to change left older people feeling vulnerable. The elderly, in particular, resisted the notion of having to travel to an out of hours centre in Drogheda. For people without private transport the thought of having to ring someone up during the night for a lift was not an attractive proposition. A number of people said they would prefer to wait until the next morning rather than disturb a neighbour or family member during the night to ask for a lift to the centre in Drogheda.
Many working parents who do not arrive home until after 6 p.m. raised legitimate concerns about the wellbeing of their children should they get sick, possibly with a childminder. The issue of the response time was also raised by a number of people. One person contacted me and stated that her son had meningitis last February. He lived because he was seen quickly by a doctor and sent to hospital immediately where he received medication in time. She said if that had happened under the new scheme, she would not be confident that her son would be alive today. Meningitis is very prevalent in the north Dublin area and the response time in such cases is a matter of great concern.
The cost of having to pay £40 for an out of service visit to Drogheda was deemed unacceptable. Many people stated this would direct many patients to accident and emergency departments in Beaumont Hospital and Our Lady of Lourdes Hospital.
A total of 46% of the population of Balbriggan are medical card holders and are under the jurisdiction of the Northern Area Health Board which has a statutory responsibility to ensure that the people under its care receive an acceptable health service. I understand that a meeting has been arranged next week with senior officials in the health board to discuss this issue. I will inform the board that any new proposals emanating from the doctors that will reduce the existing service to the people of Balbriggan are unacceptable to me and will be resisted. Any changes must result in an improvement in services, not a reduction.
Balbriggan has a population of between 9,000 and 10,000 people and it is envisaged it will grow to 40,000 in the next decade. It is long past time that the Department of Health and Children and the health authorities should bring forward a proper health plan for Balbriggan. A proper health service delivered in Balbriggan and incorporating a new hospital for the town to serve the expanding catchment area of north Fingal must be part of the plan. In the meantime the doctors in this new co-op must accept the legitimate concerns of the residents of Balbriggan. I recommend that a meeting should be set up between the health board, doctors and representatives of the people of Balbriggan to resolve the impasse that exists. The result of all this must be that an acceptable health service is provided in Balbriggan for the people – nothing less is acceptable to me.
Ar son an Aire, ba mhaith liom buíochas a ghabháil leis an bheirt Teachta a d'ardaigh an cheist seo. The provision of appropriate general practitioner and primary care services is a key element of health care services and one that the Government is committed to developing in a proper and structured way. I am aware of the public meeting, as outlined by the two Deputies, that took place in Balbriggan on Monday night concerning the provision of general practitioner services in the context of the new out of hours scheme. I am also aware that a number of people in that town are somewhat unsure of the purpose and the operation of the new general practitioner out of hours scheme. That is regrettable and will be rectified by a further public information campaign in the area. However, I understand that uncertainty has been compounded to some degree by anonymous leaflets circulated in the Balbriggan area containing certain errors of fact.
By way of background to the new service I would like to point out certain facts and realities. In recent years general practitioners have tended to reschedule their surgery hours away from nights and weekends to a more nine to five service. Many GPs are involved in rotas to provide an emergency out of hours service for their patients outside scheduled hours. Notwithstanding that, it has become increasingly evident that existing arrangements to provide services at nights, weekends, bank holidays etc., vary considerably throughout the country and are particularly variable in rural areas. This trend has been matched by increasing public concern at the lack of such services, by inappropriate recourse to hospital accident and emergency services and by a significant escalation in the costs associated with the provision of out of hours GP services under the GMS scheme. As the Deputies will recall, the existence of this problem and the need to address it have been referred to previously in the House.
Accordingly, certain projects have been developed in a number of health boards to tackle the problem. For example, in the Dublin area, DUBDOC provides an out of hours GP service from the campus of St. James's Hospital. Last year in the South Eastern Health Board area an out of hours GP service called CAREDOC was launched. That was a co-operative venture directly involving the local GPs in the organisation and management of a structured co-operative service. The success of that scheme led to the commencement on 18 September of a pilot regionwide out of hours GP co-operative project in the North Eastern Health Board region called North-East Doc.
In terms of membership, more than 130 of the doctors in the North Eastern Health Board area joined the project and the five GPs in the Balbriggan area asked their professional colleagues in the North Eastern Health Board if they could join. That request was acceded to in a spirit of professional co-operation.
Having outlined the background, I wish to make the following specific points. First, North-East Doc is a voluntary scheme, no GPs were forced to join it and presumably in deciding to join it they had regard to the best needs of their patients.
Second, critics of these initiatives argue that the patient can no longer access his or her own doctor. The reality is that no individual GP can provide 24 hour, 7 day availability to his or her patients. It is humanly impossible. What the North-East Doc project does is recognise that fact and it ensures that fully qualified GPs are readily accessible for consultations, including domiciliary visits, through one simple phone number rather than a series of answering machines and mobile phones. To ensure physical accessibility, there are a number of centres spread throughout the area covered by the scheme and doctors are driven in specifically identifiable cars where visits to patients are required. Those cars are also equipped with communications facilities that allow for ongoing consultation, if necessary, while the doctor is en route.Third, there is some evidence that medical card holders do not always fare as well as private patients in accessing out of hours services and there is a concern that urban areas are better provided for than rural areas. A regionwide scheme like North-East Doc ensures an equality of services. Moreover, it should assist in attracting doctors to rural areas generally, especially where the problem of onerous rotas in certain isolated locations could otherwise have proved a major disincentive.
Fourth, the fact that the project originates from another health board area is not inconsistent with the fact that numerous rota arrangements currently in place throughout the country cut across health board borders.
Fifth, the scheme is a pilot one, only recently established. It is being monitored and evaluated on an ongoing basis and, prior to Monday's meeting in Balbriggan, the decision was made to set up a peripheral centre in the town. The need to further develop that centre will be examined in light of experience.
With regard to the issue of the fees charged by participating doctors, as is the case when visiting their own GP, there is no charge to medical card holders under the North-East Doc scheme for GMS services provided. In the case of private patients, the fee to be charged has always been a matter for the doctor involved. North-East Doc has not changed this. However, it is worth pointing out that all patients calling North-East Doc are triaged by a GP and where it is established that there is no need for a follow-up consultation there is no cost. In addition, where the private patient concerned has seen his or her GP during the day in relation to the particular medical problem the level of the fee to be charged is normally halved.
The provision of appropriate health care is, of course, a matter that extends beyond primary care. In that regard a range of health services are provided from the local health centre in Balbriggan. These include public health nursing, dental, community welfare, community psychiatry, child health services and a mobile hospital for the elderly. Also, this year the Northern Area Health Board is undertaking some upgrading work and has included proposals in its draft development plan for the provision of a new purpose-built centre.
There are no proposals to build a new public hospital in north Dublin. Deputies will be aware that under the Programme for Prosperity and Fairness it was agreed to conduct a review of bed capacity in both acute and non-acute settings. All hospitals in the eastern region and their catchment areas will be examined in the course of the reviews and the outcomes will facilitate the ERHA in determining future policy for the planning of acute hospital services in the region.
Deputy Ryan mentioned meningitis and I refer to the scheme launched yesterday by the Minister. I hope all Deputies will encourage people to take up this scheme, particularly those deemed at risk.
I repeat that North-East Doc is a pilot scheme intended to address a particular need in a structured manner. It is being monitored and will be evaluated on an ongoing basis to ensure its efficiency and effectiveness.
The figure is 60,000, not 40,000.
The Dáil adjourned at 5.25 p.m. until 2.30 p.m. on Tuesday, 10 October 2000.