Dáil Éireann Debate, Wednesday - 11 May 2005
61 Mr. Eamon Ryan asked the Tánaiste and Minister for Health and Children the progress made to date in implementing the primary health care strategy; if a proper primary health care strategy will deal with up to 90% of illnesses; the costs for such a health care strategy; and if she will make a statement on the matter. [15372/05]
View answerThe strategy, Primary Care: A New Direction, sets out the Government's broad vision for the development of primary care as the central focus for the delivery of health and personal social care services in a modern health system. The strategy aims to shift the emphasis from the current over-reliance on acute hospital services so patients will have direct access to an integrated multidisciplinary team of general practitioners, nurses, health care assistants, home helps, occupational therapists and others. As the new primary care model is implemented, a wider network of other health and social care professionals will also provide services for the population served by each team.
The strategy provides a template for the development of primary care services over a period of ten to 15 years. The full implementation of the primary care strategy will require significant investment, over a sustained period, to expand capacity and enable primary care to become the cornerstone of our health system. Three broad approaches will be taken to enable this to happen, namely, revenue and capital investment by the State to deliver additional services; a structured role for the private sector in the development of facilities and possibly also the delivery of services; and the substantial reorganisation of the resources already in the health service.
The strategy provided an indication of the scale of resources potentially required. Those who formulated it estimated the capital cost of developing a primary care facility at some €2.5 million for each team, which is approximately €1.27 billion for the first 400 to 600 teams. The additional staffing costs involved, allowing for the availability of existing staff and taking account of the composition of typical core teams and the associated network professionals, were estimated to amount to approximately €615 million per annum for the first 400 to 600 teams. The strategy also estimated that up to €50 million in once-off costs and running costs of €12.7 million per annum would be required for ICT supports. However, as was indicated clearly in the strategy, the required investment could come from a range of sources, not solely from the Exchequer.
On implementation, one of the first steps has been to establish an initial group of ten primary care teams, with supplementary funding to enable existing staff resources within the public system to be augmented.
Among the enhanced and expanded range of services these teams are providing or developing are improved access to physiotherapy and occupational therapy, shared care arrangements with general hospitals and social work services focusing on general family support needs.
Additional information not given on the floor of the House.
The experience of the ten teams to date has shown that collaborative work among health professionals at local level supports both a shared understanding and service response to a range of health care issues, while also providing continuity of care for patients and their carers. This reflects the international consensus. It is now widely accepted that integrated team-based primary care represents the most appropriate, effective and user-friendly approach to service delivery, offering the potential to cater for 90% to 95% of all health service needs.
A significant element in the implementation of this strategy will be the reorganisation and reconfiguration of resources and services already within the health service. This reflects also one of the core principles underpinning the health service reform programme. The Health Service Executive must address this to provide a firm basis for the development of primary care teams and networks as the standard model of service delivery. I am aware that considerable work has already been undertaken by the former health boards over the past two years to map out the proposed numbers, locations and configuration of future primary care teams and the resource requirements associated therewith. The HSE must complete this task to provide a firm basis for the reorganisation of resources within primary care.
One of the most significant changes this process will require is that primary care professionals of different disciplines will have to develop strong and effective working relationships with each other, at team and network levels. The primary care model requires horizontal working and reporting across disciplines. The existing model of professional management in primary care services, in which reporting arrangements are often largely hierarchical, does not align well with the model of team-working set out in the strategy. The current contracts with general practitioners are also out of keeping with what is required of a modern, high-quality primary care service and will be the subject of detailed review in the context of the development of new contractual arrangements in respect of GPs' delivery of primary care.
I look forward to all professionals involved committing to embracing the new working arrangements I have described as a key part of the process of reforming and developing our health services.
As I have indicated, all of the investment needed to enable implementation of the primary care strategy need not involve the public sector. I am committed to developing policy in ways that will stimulate private sector investment in the development of both facilities and services. In light of the considerable private sector interest in the development of hospitals and long-term care services, I envisage much potential for such developments in primary care to complement investment by the State. I have asked the Department to consider how this agenda can be advanced in a way that will harness this undoubted potential within the non-State sector and so enable and support the delivery of integrated primary care services in line with national policy.
I thank the Minister for her reply. Does she agree that the document is excellent and acknowledges that we can deal with up to 90% of illnesses through primary care? This is an astonishing figure. However, is it not the case that the significant investment, about which the Minister has spoken, has not been forthcoming? Will she explain why the last meeting of the steering group considering primary care was cancelled? Was it cancelled because many people felt she had not stepped up to the plate — to use a phrase I heard from one of the members of the steering group — or made a commitment regarding the investment? The group wants the investment programme to be set out so it will know that circumstances will be much improved in three or four years.
The cost at the time of publication was €1.2 billion. Further costs were estimated to amount to a couple of hundred million euro per annum. We do not have these resources at present. We are increasing spending on health by 10.8%, or 8.5% in real terms. In the United Kingdom, the previous Government advocated a target of 6% growth in spending. It said it hoped to achieve it during its lifetime but has not yet done so. In both France and Germany, spending is increasing at a rate of 2%.
There is only so much one can do with the resources available. I hope that in the context of the contract renegotiated with primary care professionals, who are essentially the doctors who will lead the teams, and with the introduction of some tax incentives, we might be able to encourage greater private sector investment in primary care. There are issues concerning taxation to be cleared at EU level.
I recently met a number of GPs from Killarney who have adopted a very innovate approach. They are looking for relatively little from the State to build a state-of-the-art primary care centre in Kerry. This is the kind of model we need to replicate in other parts of the country. It is the only way we can achieve the kind of primary care strategy we all want to see implemented.
Does the Minister agree that if we had managed properly the overruns that accrued in respect of road building projects, we could have had an excellent primary care strategy?
Construction inflation was running at approximately 25% per annum some years ago because of the level of demand. That is always what happens when a sector overheats.
The country is spending €1 out of every €4 running the health service. This is not an inconsiderable amount. We have come an awfully long way, yet we all know of the deficiencies and gaps. It is a question of having a sense of priority and trying to obtain as much as we can for the money being spent. I accept there might be too great a focus on hospitals and that we should focus more on primary care. The primary providers of health care are doctors. Doctors at general practice level intervene more with patients than any other group of doctors. Some people see a consultant only once in a lifetime because they may not require further visits, but they see their general practitioners frequently. I accept that more and more resources must be directed towards primary care, coming from a very low base. However, we will not be able to obtain the sum I mentioned in the short term.
