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Primary Care Centres Provision

Dáil Éireann Debate, Thursday - 27 September 2012

Thursday, 27 September 2012

Ceisteanna (11, 19, 26, 32, 66)

Niall Collins

Ceist:

11. Deputy Niall Collins asked the Minister for Health the reason he added primary care centres to the list using a particular criteria selected by the Health Service Executive; if he has had previous connections with the general practitioners involved; and if he will make a statement on the matter. [40959/12]

Amharc ar fhreagra

Clare Daly

Ceist:

19. Deputy Clare Daly asked the Minister for Health the way the priority list for primary care centres was approved with particular reference to the changes announced in July 2012 [40940/12]

Amharc ar fhreagra

Dessie Ellis

Ceist:

26. Deputy Dessie Ellis asked the Minister for Health if he has an up-to-date-cost-benefit analysis of the development of primary care centres by means of public-private partnership as against development by the Health Service Executive directly; and if he will make a statement on the matter. [40986/12]

Amharc ar fhreagra

John Browne

Ceist:

32. Deputy John Browne asked the Minister for Health if he has had any representations from private contractors or general practitioners involved in building primary care centres ion Swords and Balbriggan, County Dublin, the two centres which were included on a list of 35 primary care centres published by the Health Service Executive in July; and if he will make a statement on the matter. [40958/12]

Amharc ar fhreagra

Dessie Ellis

Ceist:

66. Deputy Dessie Ellis asked the Minister for Health the position regarding the development of primary care centres; the locations chosen to commence development; the criteria used for choosing priority locations; and if he will make a statement on the matter. [40985/12]

Amharc ar fhreagra

Freagraí scríofa

I propose to take Questions Nos. 11, 19, 26, 32 and 66 together.

Early in 2012 the HSE put together a list of high priority locations for the development of primary care centres across Ireland. It is the intention of Government to develop as many centres as possible by one of three separate methods:

- by direct investment;

- by way of leasing arrangements;

- by way of Public Private Partnership.

The locations were then considered for development by way of PPP as part of the Government’s stimulus package.

Selecting the Primary Care Centres under PPP was not, as is generally believed, done on the basis of one criterion, the deprivation index. Three criteria were deployed:

- the deprivation index for the catchment population of the centre;

- the service priority identified by each Integrated Service Area / Local Health Office;

- an Accommodation Assessment which assessed accommodation available for the primary care team within the catchment area, the quality of the accommodation, and whether or not the accommodation was spread over more than one building.

The HSE in this new process identified 338 locations for PC centres. From this 20 were selected on the basis of accommodation availability in the locale, service priorities, and deprivation. 37 locations within the list of 338 had similar rankings.

I accepted the first list of twenty prospective centres presented by Minister Shortall, but I decided, in consultation with my Department officials and Government Ministers, to go beyond the initial mathematical model, as the number was too small and we needed at least 35 centres. Advice from the HSE/DoH based on experience of PPPs is that if only 20 were pursued, considerable slippage could arise and the health system could lose a badly needed investment. I also took into account that the track record of the HSE in delivering PCs on time is poor. In addition the €115m stimulus fund available could only be accessed by means of PPP.

I wrote to Minister Shortall on the 25 of July stating: "A very strong consensus emerged at Government level that identifying 35 locations would stimulate and encourage wider interest and participation..." In other words, if we were to identify only twenty, and stick with twenty, GPs would then be able to sit back await their completion and then enter on their terms only. If you look at what happened in an urban area where a primary care centre has been built, the process began 4 years ago with pre-contract discussions with local GPs, the building was completed in 2012, but it took several months to get the GPs to move in. A similar situation arose in a rural area. So the list was widened. In addition, new criteria were added. It was evident, for example, that consideration needed to be given to:

- Existing health facilities;

- GP to population ratio;

- Pressures on services, particularly Acute Services;

- Funding options, including exchequer funded (HSE) build or lease; and

- Implementability of a PPP (size, site and scale).

The criterion of existing health facilities was added because if they weren’t considered, you could possibly have a health centre built in the shadow of an acute hospital, while a nearby area of great need would be left without a primary care centre, which would make no sense. Under these wider criteria, 15 additions were made to the list. Some of those extra 15 had in fact been identified by the HSE as far back as 2007 as high priority (under a Fianna Fail Government). However, because of the weighting I mentioned earlier (multiplying the deprivation index by three), two of these areas – Balbriggan and Swords - both lost out. They got swept from high priority to low priority. Under the original priority system both would have been in the top 35. However, under the new system with an altered weighting system, they ended up down the list. The realities had not changed. The weighting made it look as if the realities had changed.

Here are the realities. Balbriggan is an area of high unemployment with no existing primary care centre, where the current health centre is in a very poor state. The centre in Balbriggan will, in fact, proceed under a lease arrangement. Swords has a population of 48,000, no primary care centre, and no direct public transport link to its nearest hospital, Beaumont. There can be no doubt that these two areas are high priority for primary care centres. It is my intention to further primary care developments as resources become available.

I cannot be certain of who the GPs are in the proposed Primary Care centres in Balbriggan and Swords. However, I was acquainted with all GPs in North County Dublin in my former role as an Irish Medical Organisation representative and as a GP in North County Dublin. I can confirm that since becoming Minister I have had no representations from private contractors or GPs involved in building primary care centres in Swords and Balbriggan in this regard.

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