I must now deal with a postponed division relating to the motion regarding healthcare provision in rural communities. On Wednesday, 21 February 2024, on the question, "That the amendment to the motion be agreed to", a division was claimed and in accordance with Standing Order 80(2), that division must be taken now.
Healthcare Provision in Rural Communities: Motion (Resumed) [Private Members]
The following motion was moved by Deputy Carol Nolan on Wednesday, 21 February 2024:
That Dáil Éireann:
recognises that:
— healthcare General Practice, being the patient's first point of contact with health services, provides person-centred and comprehensive care from the beginning to the end of life, often coordinating care between many agencies involved in the treatment of complex chronic illnesses;
— general practice in Ireland, providing professional quality care at the heart of the local community, is the cornerstone of the Irish health service, with General Practitioners (GPs) being the first port of call for most patients;
— over two-thirds of GPs (66 per cent) in rural Ireland are currently unable to take on new patients, with some reporting waiting times of up to two weeks for an appointment, according to a survey by the Irish Independent;
— the Irish Medical Organisation warns that Ireland, having only seven GPs per 10,000 population (one of the lowest in the European Union), falls well below the required minimum of 12 per 10,000 to ensure a safe and effective healthcare service;
— Government policy and planning has failed to ensure Ireland is training enough GPs for the population increase, leading to many GPs emigrating due to better pay, terms, and conditions abroad; in 2022 alone 442 Irish doctors were issued temporary work visas for Australia;
— the recent Irish Independent study highlights a mounting health crisis in rural Ireland, whereby a severe lack of healthcare accessibility is causing strain on residents and leading to delayed diagnoses and treatments;
— over two-thirds of GPs are currently not accepting new patients which signifies a shrinking healthcare horizon in rural Ireland;
— medical services in rural communities are currently unsustainable, as evidenced by patients reportedly waiting up to two weeks to secure a GP appointment;
— despite warnings from the Health Service Executive (HSE) years ago, little or nothing has been done at senior Government levels to address this unfolding crisis; and
— modelling suggests that by 2025 Ireland expects a shortage of between 493 and 1380 GPs, mainly in rural areas; this, coupled with an aging population and the likelihood that many GPs are due to retire by 2026 (expected to be around 700), paints a grim picture for a rural health service that is being hollowed out due to a lack of political support;
notes that:
— according to the Irish Independent study, 68 per cent of medical practices outside the country's main cities are not open to taking on new patients, reflecting a clear urban-rural divide;
— the urban-rural divide in healthcare access has stark implications, with rural patients facing significant barriers to timely medical care, despite rural areas having an older population compared to urban centres in Ireland;
— the cumulative effect of a lack of access to GPs in rural areas has led to an alarming rural health crisis, which is exacerbated by limited or absent public transport services making health services less accessible to rural people;
— the Irish Independent study found that, on average, patients in Dublin can be seen on the same day as a request for an appointment, while those in the midlands looking to book a non-urgent appointment with their GP could be waiting up to two weeks;
— the rural health crisis extends beyond patients to GPs in rural Ireland, with many practices closing down and the remaining ones grappling with overwhelming workloads due to a lack of support from the Department of Health and the HSE, resulting in onerous working conditions that deter new GPs;
— GPs often cite high insurance costs, overheads, and an overly bureaucratic system as obstacles to their patient-centred role, all of which are issues that the Government can address;
— the rural healthcare crisis extends to an emergency in dental care provision where children are forced to wait up to ten years for treatment and less than half of eligible children were seen under the school screening programme last year;
— the rural healthcare crisis is further exacerbated by a severe shortage of home helps, a worsening crisis in every accident and emergency department, an almost non-existent mental health care service, and a severe lack of residential places for people with physical and mental disabilities;
— the Irish Dental Association has previously highlighted to the Oireachtas Joint Committee on Health that children are waiting up to ten years for treatment and less than half of those who were eligible for the school screening programme have been called for treatment;
— the number of dentists registered to treat patients under the Dental Treatment Service Scheme is in freefall, requiring a complete overhaul of the contract governing the scheme; and
— the failure of the Government and the Minister for Health to address the unfolding rural healthcare crisis will likely have a grave negative effect on the health and life expectancy of the rural population; and
calls on the Government to:
— accept that the leading cause of the severely diminished access to healthcare provision in rural areas is Government neglect and inaction in adopting a strategic rural healthcare framework that incorporates increased resources by the Minister for Health and the HSE;
— end the policy and practice of addressing all healthcare policy problems through a narrow Dublin-based approach, and recognise the healthcare problem in rural Ireland, accepting that rural residents deserve equal access to healthcare;
— explain how, despite an increased national health budget, the country is witnessing a steady deterioration of health services, especially in rural communities;
— urgently address the rural health crisis by establishing a high-level Ministerial working group or Cabinet sub-Committee to generate immediate, medium-term, and long-term solutions, and report to the Dáil within four weeks from this day with a strategic roadmap to reverse this decline;
— immediately implement a strategic 'rural proofing' and 'patient first' approach to all healthcare policies;
— acknowledge that trying to recruit more GPs or allied health professionals from abroad is unlikely to succeed given the global shortage of both these groups of professionals;
— increase the number of GPs through sustained Government funding and a long-term GP workforce strategy and plan, addressing the unhealthy work climate for GPs by improving support, reducing their administrative workloads, and tackling their patient workload intensity and volume, as well as long hours;
— implement policies that will make the provision of rural healthcare attractive for young doctors, such as offering scholarships to medical students from rural areas to return and practice in their home areas;
— ensure the HSE changes policy and puts in place new salaried GP posts where vacancies remain unfilled in rural areas, along with providing premises and staff in areas where the patient list is small; and
— recognise that action is long overdue and the fact that Ireland does not have enough GPs to meet patient numbers, especially in rural Ireland, which constitutes a national health emergency that needs to be treated as such.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"recognises that:
— access to effective and sustainable general practice services is a cornerstone of the delivery of healthcare;
— the Government, recognising the importance of general practice and acknowledging the challenges faced in some areas to maintain sustainable general practice services, has significantly increased investment in general practice in recent years;
— expenditure on general practice has increased from €561 million in 2019 to €784 million in 2022, with expenditure in 2023 likely to exceed €800 million;
— some areas are experiencing challenges in attracting General Practitioners (GPs);
— the implementation of the 2019 GP Agreement increased the Rural Practice Grant by 10 per cent, increasing the financial support to rural GPs;
— the Government has increased the number of GP training places from 258 in 2022 to 286 in 2023 and 350 in 2024;
— applications to join the GP training programme in 2024 reached the record-high level of 1,311 medical graduates;
— research undertaken by the Department of Health indicates that for every GP retiring over the coming four years one and a half to three GPs will enter practice;
— the Government has provided funding to the joint Irish College of General Practitioners/Health Service Executive (HSE) non-EU Rural GP initiative that resulted in the recruitment of 112 GPs from outside Ireland in 2023, with 75 already in place by year-end;
— the Government has provided funding to increase the number of GPs recruited under the non-EU Rural GP Initiative to up to 250 in 2024;
— Irish College of General Practitioners surveys have demonstrated that a large majority of GPs graduating from training intend to remain and to work in general practice in Ireland;
— the role of general practice is continually evolving to include new and innovative services, such as the Chronic Disease Management Programme which helps patients living with chronic obstructive pulmonary disease, asthma, chronic heart disease, and diabetes to proactively manage their conditions in the community, improving quality of life;
— the Government has put in place the resources to allow GPs to refer patients directly to diagnostic services, resulting in reductions in waiting times and earlier diagnosis;
— this Government has consistently made significant increases in expenditure on health services, resulting in an increase of 26,000 staff in the HSE, an additional 1,126 acute hospital beds, 25 per cent more intensive care beds, and a fall in hospital waiting lists for two years in succession in 2022 and 2023;
— there has been considerable additional investment in oral healthcare services in recent years, including an expansion in 2022 of care available within the Dental Treatment Services Scheme for adult medical card holders and a 40-60 per cent increase in fees paid to dentists across most treatment items; and
— sustained investment in recent years has reduced the numbers of children waiting to access public orthodontic care by 47 per cent between 2019 and 2023; and
agrees that:
— the Government is committed to fundamentally reforming dental services through implementation of the National Oral Health Policy, Smile agus Sláinte and that the HSE’s Strategic Reform Lead will drive service reform for adults and children in line with policy in 2024;
— increased investment is making general practice in both urban and rural areas a more attractive career prospect for medical graduates;
— the initiatives taken by the Government to increase the number of training places and to recruit non-EU GPs will result in an increase in the number of GPs providing services in both urban and rural areas; and
— the measures supported by this Government will result in an increase in the ratio of GPs to population and improved services for patients.".
- (Minister of State at the Department of Health, Deputy Mary Butler)
Amendment put:
The Dáil divided: Tá, 70; Níl, 60; Staon, 0.
Tá
- Brophy, Colm.
- Browne, James.
- Bruton, Richard.
- Burke, Colm.
- Burke, Peter.
- Butler, Mary.
- Byrne, Thomas.
- Cahill, Jackie.
- Calleary, Dara.
- Cannon, Ciarán.
- Carroll MacNeill, Jennifer.
- Chambers, Jack.
- Coveney, Simon.
- Cowen, Barry.
- Devlin, Cormac.
- Dillon, Alan.
- Donnelly, Stephen.
- Donohoe, Paschal.
- Duffy, Francis Noel.
- Durkan, Bernard J.
- English, Damien.
- Farrell, Alan.
- Feighan, Frankie.
- Flaherty, Joe.
- Foley, Norma.
- Griffin, Brendan.
- Harris, Simon.
- Haughey, Seán.
- Heydon, Martin.
- Higgins, Emer.
- Humphreys, Heather.
- Lahart, John.
- Lawless, James.
- Leddin, Brian.
- Madigan, Josepha.
- Martin, Catherine.
- Martin, Micheál.
- Matthews, Steven.
- McAuliffe, Paul.
- McConalogue, Charlie.
- McEntee, Helen.
- McGrath, Michael.
- McGuinness, John.
- McHugh, Joe.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Murnane O'Connor, Jennifer.
- Naughton, Hildegarde.
- Noonan, Malcolm.
- O'Brien, Darragh.
- O'Brien, Joe.
- O'Callaghan, Jim.
- O'Connor, James.
- O'Dea, Willie.
- O'Donnell, Kieran.
- O'Donovan, Patrick.
- O'Dowd, Fergus.
- O'Gorman, Roderic.
- O'Sullivan, Christopher.
- O'Sullivan, Pádraig.
- Ó Cathasaigh, Marc.
- Ó Cuív, Éamon.
- Rabbitte, Anne.
- Richmond, Neale.
- Ring, Michael.
- Ryan, Eamon.
- Smith, Brendan.
- Smyth, Niamh.
- Smyth, Ossian.
- Troy, Robert.
Níl
- Andrews, Chris.
- Bacik, Ivana.
- Barry, Mick.
- Berry, Cathal.
- Brady, John.
- Browne, Martin.
- Buckley, Pat.
- Cairns, Holly.
- Canney, Seán.
- Clarke, Sorca.
- Collins, Joan.
- Connolly, Catherine.
- Conway-Walsh, Rose.
- Cronin, Réada.
- Crowe, Seán.
- Cullinane, David.
- Daly, Pa.
- Doherty, Pearse.
- Donnelly, Paul.
- Ellis, Dessie.
- Farrell, Mairéad.
- Funchion, Kathleen.
- Gannon, Gary.
- Guirke, Johnny.
- Harkin, Marian.
- Healy-Rae, Danny.
- Howlin, Brendan.
- Kelly, Alan.
- Kenny, Martin.
- Kerrane, Claire.
- Lowry, Michael.
- Mac Lochlainn, Pádraig.
- McDonald, Mary Lou.
- McGrath, Mattie.
- McNamara, Michael.
- Mitchell, Denise.
- Munster, Imelda.
- Murphy, Catherine.
- Murphy, Paul.
- Murphy, Verona.
- Mythen, Johnny.
- Nash, Ged.
- O'Callaghan, Cian.
- O'Reilly, Louise.
- O'Rourke, Darren.
- Ó Broin, Eoin.
- Ó Murchú, Ruairí.
- Ó Ríordáin, Aodhán.
- Ó Snodaigh, Aengus.
- Quinlivan, Maurice.
- Ryan, Patricia.
- Shanahan, Matt.
- Sherlock, Sean.
- Shortall, Róisín.
- Stanley, Brian.
- Tóibín, Peadar.
- Tully, Pauline.
- Ward, Mark.
- Whitmore, Jennifer.
- Wynne, Violet-Anne.
Staon
Tellers: Tá, Deputies Hildegarde Naughton and Cormac Devlin; Níl, Deputies Mattie McGrath and Danny Healy-Rae.
Amendment declared carried.
Motion, as amended, put and declared carried.