Thursday, 10 October 2019

Questions (3)

John Brassil


3. Deputy John Brassil asked the Minister for Health the status of the decisive shift to primary care pledged in the Programme for Partnership Government; and if he will make a statement on the matter. [41486/19]

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Oral answers (28 contributions) (Question to Health)

I ask for an update on the decisive shift to primary care pledged in the programme for Government and reiterated in the Sláintecare document. Everybody accepts that the cornerstone of our future health strategy is to fully resource our primary care services and by doing so we may, in some way, make progress in improving our health services. Unfortunately, to date I see no evidence of this decisive shift.

I thank Deputy Brassil for his question and work on the Sláintecare strategy where it clearly came to the fore that funding community care and making that decisive shift is absolutely key. I want to assure him that we remain fully committed to the development of primary care. It is recognised that countries with a strong primary care sector have demonstrably better outcomes, lower mortality rates and lower overall health care costs.

As we have seen in recent years, there has been a significant investment in primary care centres around the country and 127 are now open. I want to be clear. They are not busy enough in terms of the volume we could be doing to provide services through primary care. That is not a criticism of the staff, who are excellent. We need to resource them to do more. That is why I am very pleased that in the budget announced this week we have received multiannual funding for 2020 and 2021 to hire 1,000 additional front-line staff to work in primary and community care. That means more public health nurses, speech and language therapists, physiotherapists, psychologists, counsellors, occupational therapists and the sort of people one would expect to be part of a community team. This will properly staff our network.

In line with Sláintecare, a rough estimate shows that about 4,000 additional staff are needed to work within the community if we are to make the Sláintecare vision a reality. This will enable us to deliver 1,000 additional posts, a quarter of what we actually need. We are committed to delivering the 4,000 additional staff over ten years. To be very clear, I have spoken to the CEO of the HSE about funding and there will be funding to hire staff for the 1,000 posts by the end of this year because of the commitment given by the Minister for Finance, Deputy Paschal Donohoe, on the floor of Dáil Éireann in his budget day speech. In the budget day book at there is reference to a €60 million full year cost for those staff. Any misinformation or confusion about that need not exist.

As Deputies know, given that I have been questioned about this very regularly, we have also reached a new agreement with our GPs. The agreement sees a decisive shift, in that from January people will be treated in GP clinics, rather than hospitals, for conditions such as asthma, heart failure and other chronic diseases. I want to do more with pharmacists and I may have an opportunity to talk about that at a future date.

I wish to bring the Minister back to one figure. He said €60 million was available for the next two years, but only €10 million of that is for 2020.

That is putting stuff into the never-never. A figure of €10 million will equate to 160 whole-time equivalents. This is minuscule compared to what is needed. The announcement sounds positive but stretching it out over two years will mean that its immediate effect will be minimal, which is the issue I continually have. We talk about the need for 1,000 extra GPs, 1,200 extra practice nurses and 1,100 public health nurses but we are nowhere near achieving those targets. Every time we make an announcement, it puts something over a period of two years and we just roll on. Who knows where we will be in 2021? The Minister and I might not even be here. We need action now. The figure of €60 million sounds positive but in reality, putting only €10 million into next year is window dressing.

Whatever about my future, I am sure the Deputy will be here continuing to make a positive contribution. I assure him that I fully agree with some of the latter end of his contribution because he and the other members of the Sláintecare committee having rightly been putting pressure on the Government to deliver multi-annual funding. If we think we are going to fix the challenges of the health service and bring about Sláintecare by just looking budget to budget, we will fail. That is why one of my biggest asks of the Minister for Finance in budget 2020 was to give me multi-annual funding for Sláintecare. Last year, I succeeded in getting multi-annual funding for the GP contract, which is making that decisive shift and has been accepted by 95% of GPs. My big multi-annual ask this year was for €60 million in a full year. It is not the never-never. As the Deputy is well aware, the recruitment process will mean that all 1,000 posts can be filled by 31 December. We will have 1,000 people there and the full year pay bill for that will be €60 million. If I did not get that full-year cost, the Deputy's criticism would be entirely correct but I have now been able to give Paul Reid, the CEO of the HSE, the certainty that on 31 December 2020, he can have 1,000 additional speech and language therapists, physiotherapists, public health nurses and others on his pay bill for the HSE. That will make a real difference and a decisive shift. The GP contract is already making that decisive shift with more patients, starting with older people, getting appointments with their GPs instead of having to trek to hospital. We must make community and primary care busier, which is what the investment is about.

I might go back a step. In reply to a parliamentary question from Deputy Donnelly during the summer, it emerged that if one compares the final budget spend for 2018 in primary care with the budget spend projection for 2019, one comes up with a reduction of €7 million. If one breaks it down into the community healthcare organisations, CHOs, one can see that there is a significant reduction in CHOs 1, 2, 3, 5, 7, 8 and 9. I have those figures and will give them to the Minister. They are factual. How can we roll out improved services if the spend of 2019 in every CHO bar two is less? It does not match up.

The Minister referred to the GP contract and the progress there. Stating my obvious conflict of interest in this area, I note that the Minister committed to rolling out a new contract for pharmacists and resolving the financial emergency measures in the public interest, FEMPI, by 2020. I ask him to hold to that commitment.

I will honour that. I had a good conversation with Darragh O'Loughlin, chief executive of the Irish Pharmacy Union, last week when representatives of the union came in to discuss some very important work it is doing on our Brexit preparedness, for which I thank it. I had hoped to begin initial engagement on some of the issues in pharmacy this year with a view to formal talks starting at the beginning of 2020. Pharmacists are coming up with solutions and ideas. We just need to make sure that what they are offering to do is added value or in other words, it is not duplication. We need to have that discussion about who does what in primary care and I am looking forward to having that discussion with our pharmacies. We must also have a discussion about contraception and the role of pharmacy vis-à-vis the role of the GP. I expect to publish the contraception report in the coming days.

Regarding individual figures at the end of the year, out of a budget of €16 billion, €17 billion or €18 billion, people can identify €1 million here and €7 million there - relatively small figures. This highlights the need for a multi-annual approach. We have €220 million for GPs over four years. That is primary care. We have €60 million for Sláintecare funding over 2020 and 2021. More money is going into primary care. We have so many primary care centres in all of our constituencies. We have the bricks and mortar; we must make them work in terms of taking that activity out of the hospitals and putting it into primary care. I genuinely believe that budget 2020, while only a start, is a real start in that shift.

The next question is Question No. 4 in the name of Deputy Barry.

I wish to ask the Minister about the cut in the rehabilitation training allowance-----

The Minister of State, Deputy Finian McGrath, is taking the question but is not yet in the Chamber.

Did the Minister speak to the Minister of State this morning?

I believe he is due to be here but I do not wish to detain Deputy Barry. The Minister of State has the documentation.

Could we hold on for a minute to see whether the Minister of State arrives?

If he will be here in the next ten minutes, we will hold. Otherwise, I need to ask the Minister.

Of course. I am more than happy to answer.

I cannot hold up the business of the House for ten minutes. I could give the Minister of State a minute or two to get here.

I am happy to go to the next question and wait for the Minister of State's reply later.

Unfortunately, Deputy Connolly has not yet arrived. Does the Deputy want the Minister to take his question?

If the arrangement is that the Minister of State will take my question, I am happy to wait for him.

We will wait for a short period of time. Deputy Connolly has agreed to take a written reply so she will not be here. Therefore, we will give the Minister of State two minutes to get here. If he is not here by then, I will move on to Other Questions.

I put down Question No. 25, which I could take now.

I have no doubt Deputy Brassil would like to take Question No. 25 but, unfortunately, I cannot-----

I have put down Question No. 11, which I could take.

I have Question No. 14.

Perhaps the Deputies should put all the numbers they mentioned into a lotto slip for Saturday night. Seeing as there are no budget discussions today, I thought the Minister of State would be here but, obviously, he has been held up somewhere.

Deputy Barry has put down Question No. 11. I suggest we swap the order of the questions so I could take Question No. 11 now.

I understand that Deputy O'Loughlin, who has put down Question No. 6, is almost here. If she does not arrive in the next few moments, I have no problem with taking Question 11 but I understand that a number of Deputies are coming so we should give them the chance. I understand Deputy Buckley has permission to take Deputy Jonathan O'Brien's Question No. 10 and will be next, if those Deputies do not turn up.

I need the permission of the House to move on to Ceisteanna Eile, that is from Question No. 6 onward. Is Deputy Brendan Smith willing to put his question to the Minister now?

We will go back to Deputy Barry's question when the Minister of State, Deputy Finian McGrath, arrives. Is that agreed? Agreed. I apologise for rushing Deputy Smith on this.