Dan Neville
Ceist:36 Mr. Neville asked the Minister for Health and Children the progress on the primary care implementation projects; and if he will make a statement on the matter. [10841/04]
Amharc ar fhreagraWednesday, 7 April 2004
Ceisteanna (41)
Freagraí scríofa
The strategy, Primary Care: A New Direction, provided for the early establishment of a number of primary care teams on the basis of the principal features of the integrated interdisciplinary model described in the strategy. One of the purposes of these projects was to allow the future more widespread implementation of the model to draw on experience gained and to be informed by the input of the relevant professional and user stakeholders to the development of the first teams. The strategy also committed to the refinement and development of the model by agreement through the joint learning that these initial implementation projects will allow for.
In October 2002 I gave approval to the establishment of ten primary care implementation projects, one in each health board area. These projects are building on the services and resources already in place in the locations involved so as to develop a primary care team in line with the interdisciplinary model described in the strategy. The spread of locations, ranging from the centre city urban areas to dispersed rural communities, has been chosen to reflect the variety of circumstances around the country in which primary care services must be delivered and to explore in a practical way how primary care teams will operate. Each location has its own intrinsic challenges and each primary care team will have to adapt to the needs of the area and community it serves.
The locations of the ten implementation projects are: Eastern Regional Health Authority; East Coast Area Health Board, Arklow, County Wicklow; Northern Area Health Board, Ballymun, Dublin city; South Western Area Health Board, Liberties, Dublin city; Midland Health Board, Portarlington, County Laois; Mid-Western Health Board, west County Limerick; North Eastern Health Board, Virginia, County Cavan; North Western Health Board; Lifford, County Donegal; South Eastern Health Board, Cashel, County Tipperary; Southern Health Board, west Kerry; and Western Health Board, Erris, County Mayo.
In 2002, initial revenue funding of €0.877 million was provided. In 2003, an additional €3.623 million in revenue funding was provided on an ongoing basis. This brought the total annual revenue funding to €4.5 million.
In 2004, I provided an additional €990,000 million to the health boards on an ongoing basis in respect of implementation of the primary care strategy and health boards may, if necessary, use this to meet any additional revenue costs associated with the primary care teams.
In 2002, I provided funding of €1 million to support information and communications technology developments for the implementation projects, and a total of €2 million to facilitate minor capital works. There has been substantial progress to date with the development of primary care teams in the chosen locations. However, it must be recognised that moving to the interdisciplinary model of service delivery poses a range of challenges for both the health professionals involved and for the health boards, who have the responsibility for leading the developments. The range of issues which must be worked through as part of the development process includes: developing the team and agreeing teamworking processes; enrolling clients with the team; managing direct patient access to team members; appointment of additional staff; ensuring that all team members are providing services to the same population; involving the community in the development process; addressing information and communications technology needs; all of these issues need to be addressed in detail and this process must involve those who will be working directly as members of the team. In several cases a number of the additional staff members required to enable the teams to deliver the full range of planned services have been appointed. Health boards must ensure that in appointing additional staff they do not exceed their authorised employment numbers and in a number of instances this has been cited as having delayed the putting in place of the full primary care team.
Projects are currently at different stages of development, with a number already providing new or enhanced primary care services to their target populations. Even at this early stage, some of the benefits which were anticipated for both service users and I understand providers are becoming evident in these cases, as new or improved primary care services are developed. Areas which are the focus of early efforts to provide new or enhanced services include physiotherapy, which has traditionally been provided as a hospital outpatient service, shared care arrangements with the general hospitals, and the development of social work services which will focus on general family support needs. I acknowledge the commitment of the front-line health professionals and the health board administrative staff involved, who have devoted considerable effort to the development of the teams to date.
The primary care strategy also indicated that a significant component of the development of primary care teams, in the short to medium term, would involve the reorientation of existing staff and resources. In 2003 my Department requested the health boards to examine how the existing primary-community care resources can best be reorganised so as to give effect to the application of the teamworking concept, as described in the strategy, on a wider basis and to map out the geographical areas to be served by primary care teams in the future. The health boards have also been asked to undertake a high-level needs assessment for primary care, which will help to inform this planning task.
The primary care strategy acknowledged that the current health board structures are not optimised to support the development and reorganisation necessary to implement the new primary care model on a widespread basis. The new structures being developed under the health service reform programme will ensure that the system is organised and managed so as to support the development and implementation of the health strategy, including the primary care strategy. The structures will be designed to achieve consistent and comprehensive implementation of national policy and to manage and drive the establishment of primary care teams and networks as the standard model of service delivery. The experience gained in the initial group of implementation projects will provide valuable learning which can inform the wider implementation which is to follow.