List of centres was revised and redrawn repeatedly from initial 22 up to final 36
ANALYSIS:That the list evolved was not unusual. But why no explanations – and why two on Reilly’s turf?
The development of primary care centres across the country formed a key element of a €2.25 billion economic stimulus package announced by the Government in mid-July.
As part of the plan, which also featured roads and schools, about €115 million was to be earmarked for the development of these centres where GPs and other health professionals could operate from a single premises.
However, newly released official Department of Health files show that the location of these centres was being altered virtually right up until the final announcement was made in the afternoon of July 17th last.
The list of primary care centres that emerged from this process has proved hugely controversial for the Government since The Irish Times revealed in September that Minister for Health James Reilly had added two locations, at Swords and Balbriggan, in his own constituency in north Co Dublin.
The row over the issue saw the resignation of minister of state at the Department of Health Róisín Shortall who, at the time, had responsibility for primary care.
She later accused Reilly of “stroke politics”.
Several months earlier, Reilly and Shortall had instructed the Health Service Executive to carry out an accommodation needs assessment for primary care teams around the country. Ultimately, the HSE produced a list of the 297 areas where centres should be sited.
Reilly and Shortall met on February 29th and she maintained there was an agreement that “the provision of centres should be informed by needs analysis, with priority given to areas of urban and rural deprivation”.
A “final” list of 22 sites (20 plus two reserves) to be developed by public-private partnerships was drawn up, headed by Laytown/Bettys-town, Co Meath, and Gort, Co Galway. Neither Swords nor Balbriggan figured on this list.
A revised list of 30 locations was later drawn up after the criteria were tweaked by tripling the weighting attached to deprivation.
This list, headed by Rowlagh/North Clondalkin and Dungloe, Co Donegal, was circulated on July 12th. Again, neither Balbriggan nor Swords featured.
The newly released files, containing hundreds of pages, show that the list had increased to 31 locations by July 13th.
On July 16th, the day before the launch of the stimulus plan by the Taoiseach, the Department of Public Expenditure and Reform told the Department of Health that there had been a change of plan and it was now intended to publish the list of locations for the new primary care centres.
By this stage, the list had grown again to 33 locations, with the first 20 to be delivered by public-private partnership. Again, Swords or Balbriggan were not included.
At 8pm on the night before the announcement, the Department of Health emailed the Department of Public Expenditure and Reform with “the final list”. This had now grown to 35 locations.
Swords and Balbriggan were the final two locations on this list. Yet the following morning just before noon – and only a couple of hours before the formal launch of the plan – the locations changed again.
Jump to 36 locations
An email from the Department of Health to the Department of Public Expenditure and Reform – titled “we now have 36 locations” – said that, among other changes, Ballaghaderreen in Roscommon had been added.
“Crumlin/Drimnagh – now two locations, Kilkenny is new, Castlecomer is out, Oranmore is out.”
The files do not spell out the rationale behind the changes.
Reilly has consistently defended his decision. He said he took advice in his department as well as from the HSE and also consulted a number of ministerial colleagues.
Reilly has denied he had agreed with Shortall that priority would be given to areas of urban and rural deprivation in the selection of projects.
In the Dáil last month, he said the criteria behind his decision were “quite extensive and because all of them act in different ways, it is a bit like a multiplier . . . It is a logistical, logarithmic progression. There is nothing simple about it.”