Tuesday, 26 November 2019

Ceisteanna (39)

Louise O'Reilly


39. Deputy Louise O'Reilly asked the Minister for Health the staff, by occupation, working in each primary care centre run by the HSE; and the vacancies in each. [48902/19]

Amharc ar fhreagra

Freagraí ó Béal (6 píosaí cainte) (Ceist ar Health)

We know there are significant vacancies in primary care right across the State. I do not expect the Minister to dispute that, but perhaps he will. Some of those vacancies exist because GPs have retired or because we simply cannot get GPs to fill the vacancies, but there are a number of vacancies in primary care centres that are run and staffed by the HSE. That is a matter that falls within the remit of the Department. It is something I believe more effort could and should be made to resolve.

I thank Deputy O'Reilly for the question. The development of community and primary care services is a key priority for the Government and primary care centres support this goal by providing a setting in which a range of health professionals can deliver better care, closer to people's homes in their local communities.

Data, as requested in the question, on the number of staff working in individual centres are not compiled centrally by the HSE, nor are vacancies identified within a specific building. There is a rationale for that, as I am sure the Deputy will appreciate, namely, that staff work across their local community and are not assigned solely to a particular centre. Nonetheless, I have asked the HSE to endeavour to get the information as best we can for the Deputy. However, the HSE does acknowledge the requirement to develop integrated reporting systems that would support timely reporting of staff both by service area and location.

Nationally, there are more than 10,600 staff working in primary care and it is estimated that around 1,800 of these staff were working in primary care centres as of November 2018. Many other staff will provide visiting clinics or other services at primary care centres, while some centres may also house mental health or social care staff and others will host visiting clinics run by consultants from acute settings. In addition, centres are used for training, education and other staff or community development programmes. As such, I have no doubt that investment in primary care centres and primary care staff is benefiting local communities.

Alongside infrastructure - this is a crucial point - we are also investing in staff. Deputy O'Reilly makes the point to me regularly that we can have all the shiny buildings we want but we need to staff them properly. I am pleased that in budget 2020 we received a multi-annual commitment for €60 million for what I call the Sláintecare workforce. That will provide 1,000 additional staff in community settings by 31 December 2020. That is a commitment the CEO of the HSE has given me. Roughly speaking, we need about 4,000 additional staff in the community if we are to reach the Sláintecare goals and to achieve the Sláintecare targets. The 1,000 staff is the first tranche and I hope we can build on that with 1,000 each year in the following budgets.

With the greatest respect, if the Minister is not identifying where the vacancies are, it strikes me that he is making it very difficult for himself to plug the gaps. I have asked parliamentary questions on this matter 17 or 18 times. The question relates to my area, which is a microcosm of what I believe is happening throughout the system. When I ask if we are getting additional staff in the primary care centre in Balbriggan, the youngest town in the State, which is in the fastest growing constituency in the State, the answer I get is that services will be provided from within existing resources. That is a very polite and nice way of saying it will not be getting any additional staff. The Department can come back with that answer and be clear that services will be provided from within existing resources, meaning there will not be any additional staff, and yet the Minister tells me that those staff have not been identified. Sláintecare is very clear on where the staff should be and what type of staff are needed, such as physiotherapists and occupational therapists, but we are also talking about directly employed GPs. Let us not forget that a motion was passed here in the House, with unanimous support, calling for the employment of directly employed GPs where that is necessary. If the Minister is not looking at the needs in areas and identifying where the gaps are, then it strikes me that it will be very hard to fill the gaps and to deliver the service. We have a plan and it should not be that hard to stick to it.

The Deputy's comments are reasonably fair, except that perhaps they miss out on one point. For the first time we are now beginning to map out the actual requirements in each of the new regional health organisations. As the Deputy is aware, we will be setting up the six new regions to slim down the HSE nationally and to devolve more to the regions in line with the Sláintecare report. That does mean a mapping exercise, and one not based on the buildings but on the population health needs. In Deputy O'Reilly's regional health area, the question is how many people are required to fill positions in speech and language therapy, occupational therapy, physiotherapy and public health nursing to meet the needs of the community in a timely fashion. That exercise is already under way. The 1,000 additional staff we will hire in the community will constitute the first tranche of that significant investment.

It is fair criticism to say that we have invested a lot in buildings and now we need to catch up in terms of investment in people. Usually, every budget day we get asked how many extra nurses and doctors we have hired in hospitals. I do not suggest that is not important, but this year is the first year that we have put forward a budget that has a very significant increase in the number of staff that are going to work in the community.

On the issue of directly employed GPs, I agree it has happened in some areas but I accept not many. I visited one area in the north inner city where directly employed GPs are providing a service that was never previously provided. That option remains open to the HSE in any area.

It is my contention that there is not a primary care centre in the State that is fully staffed with a multidisciplinary team in operation. I do not believe there is one offering a full range of services. It is a little bit disingenuous that time after time, when we question the Minister for Health or the Taoiseach about long waiting lists or overcrowding in accident and emergency departments, we are told that people should not go to accident and emergency departments if they do not need to. However, it is the only door that is open to them. We are not identifying where the staff are needed, by virtue of the population and its needs, and trying to shore up some of that deficit now. In north County Dublin, children wait 33 months for early intervention. We could just stop calling it that because it is insulting to wait 33 months for early intervention. Therapies such as occupational therapy and speech and language therapy can and should be provided within a primary care centre but they are not being provided at present. I do not hear anything from the Minister to give comfort to the parents that are waiting at the moment. What we really need to know is when the HSE will start to provide the staff. How will the staff be put in place if the gaps have not been identified?

The appointment of directly employed GPs must be ramped up because the GP is the heart of the primary care centre and if GPs are not coming in on the basis of the small-business model, their appointment must be accentuated directly by the HSE.

I agree with Deputy O'Reilly. I have had conversations with the HSE about that and it is clear in its mandate in that regard.

Deputy O'Reilly used the word "disingenuous" and I do not wish to use it back, but perhaps she is choosing not to listen to what I said in that regard. We got funding in last month's budget to hire 1,000 additional people in the community. We are now carrying out the mapping exercise. We are setting up a discrete programme of work in the Department and the HSE to monitor that. I am sure Deputy O'Reilly will, rightly, table a parliamentary question on how many of the 1,000 additional staff have been hired. The answer needs to be 1,000 by 31 December 2020. Whoever is here for budget 2021 - I hope we all are - will need to continue that. I am being very honest. I have asked how many extra staff the HSE believes we need in primary care to achieve the Sláintecare vision and the estimate is approximately 4,000. The next body of work is to map that out across the regional health organisations by specialty as well. That work is ongoing in the Department and in the HSE and the provision of those 1,000 additional posts will be the first real evidence-based example of that.

Question No. 40 replied to with Written Answers.