BACKGROUND:Five new areas were added to final list with no mention made of deprivation in selection, writes PAUL CULLEN
FOR MORE than a decade, primary care has been the cornerstone of the health policy of successive governments. The idea is to have most people’s medical needs met close to home by teams of doctors and other health professionals housed in primary care centres. Hospitals, which are more expensive to run, would then focus on the most serious medical cases.
But the provision of primary care centres went from desirable to urgently required when the current Government came to power with a promise to introduce universal and free primary care during its lifetime. This commitment wouldn’t mean much unless people could access modern centres close to where they lived.
So last year Minister for Health James Reilly and his Minister of State Róisín Shortall instructed the HSE to carry out an accommodation needs assessment for primary care teams around the country. The idea was to identify areas where gaps in provision existed and to suggest what approach could be taken to plug these gaps.
This assessment, completed in October 2011, found that only 55 primary care teams were in place, while 415 teams needed accommodation in 297 centres (some centres would house more than one team).
The last government favoured developing centres by leasing sites from the private sector, but the assessment found that many submissions made by developers were highly speculative. The economic downturn was also blamed for delays, plus the fact that many GPs had invested significantly in their premises in recent years and were unable to dispose of them.
The HSE officials carried out a detailed analysis of current and future needs for primary care centres throughout the State before drawing up a list of the 297 areas where they would be sited.
Reilly and Shortall met on February 29th and agreed, according to minutes, that “the provision of centres should be informed by needs analysis, with priority given to areas of urban and rural deprivation”.
In April, Shortall instructed the officials to rationalise the list down to 200 centres. She said the existing private leasing arrangements were moving too slowly and were failing to help target the areas of greatest need. The use of private-public partnership arrangements was prioritised with a view to focusing on areas of urban and rural deprivation.
The officials developed a scoring system based on deprivation levels, their assessment of service priorities in an area and an assessment of available accommodation. The resulting league table was headed by Knocknaheeny in Cork, followed by Rialto/The Coombe in Dublin. Balbriggan was in position 44 and Swords South was 130th of the top 200 locations listed.
The HSE estimated the cost of providing 22 centres through private-public partnerships at €12-€14 million a year, or up to €350 million over 25 years.
A “final” list of 22 sites (20 plus two reserves) to be developed by private-public partnerships was drawn up, headed by Laytown/Bettystown, Co Meath, and Gort, Co Galway. Neither Swords nor Balbriggan figured on this list.
According to the Department of Health file on the matter, however, which has been seen by The Irish Times, Shortall told her officials on July 3rd she was not happy with the list. They tweaked the criteria for assessing sites by tripling the weighting attached to deprivation.
A revised list of 30 locations, headed by Rowlagh/North Clondalkin and Dungloe, was circulated on July 12th. Again, neither Balbriggan nor Swords figured on this list.
The remaining document on the file is the press release issued by the department five days later, on July 17th. This time, the list had grown to include 35 locations of which 20 are to be developed. The list includes the 30 locations on the previous list, plus five others – Balbriggan, Swords, Kilkenny, Darndale and Ballaghaderreen.
None of these five locations figured in the top 20 or 30 sites from the list previously drawn up by the HSE. No mention of deprivation, or any other criterion used in selecting sites, was made in the press release.