Minister for Health defends move on primary care sites

 

Minister for Health James Reilly has defended his decision to add two locations in his north Dublin constituency to a HSE list of places chosen for primary care centres.

Earlier, Minister of State for Primary Care Róisín Shortall said he had questions to answer about the move, which was done without her knowledge.

Swords and Balbriggan were among five locations added to the priority list for building new primary care centres announced by the Minister last July. Neither featured in lists of the top 30 locations which the HSE recommended should receive priority.

Government policy, repeatedly stated by the two Ministers, is that priority for primary care centres be given to areas of urban and rural deprivation.

Dr Reilly's move was revealed in documents obtained under freedom of information by The Irish Times.

Speaking this afternoon, Dr Reilly said the original criteria for selecting the locations was based on the Urban Deprivation Index. “But considerations must be much broader than that, must consider the location of existing health facilities in the area, and accessibility,” he told RTE’s News at One.

“I made this decision, and I know [Ms Shortall] disagrees with it. But I have made the decision, and I have the authority to so do, I did so with good reason, I took advice here in the Department, I took further advice from the HSE, and I also consulted several ministerial colleagues. I have made the decision, and if I had to make the decision again I would make the very same decision.”

He said Balbriggan has the second highest density of unemployment in Dublin, and does not have direct links to Beaumont or Drogheda. He said Swords has a population of 48,000, no primary health centre, and no direct link by public transport to Beaumont.

Dr Reilly said the HSE has signed a lease to provide a primary health care centre in Balbriggan, and a planning application will be submitted next month. “The GPs are on board,” he said.

It is also in “advanced negotiations” about leasing a premises in Swords. “And no, it’s not on a site I own,” he said.

When asked by reporters in Balbriggan this morning why the sites were added, Ms Shortall replied: “That’s not a question for me, that’s a question for Minister Reilly. I don’t know why.”

Despite being asked three times if she had confidence in Dr Reilly, Ms Shortall declined to explicitly back him. “There’s a very difficult job to be done. Minister Reilly and I need to work closely together, we need to recommit to the programme for government,” she said. “We need to resolve policy differences that do exist there. We are two different parties.”

Ms Shortall had raised the issue in her speech on the no-confidence motion in the Minister last Wednesday night, when she called for decisions on primary care centres to be transparent and objective.

Dr Reilly noted today that she voted confidence in him. “Actions speak louder than words,” he said.

Minister for Education Ruairí Quinn said this morning Dr Reilly has his confidence and his sympathy “because he’s inheriting an incredible mess” in the health service. “He has a very difficult task to do and he needs the support of all his colleagues in Government and he certainly has mine,” he said in Cork.

Fianna Fáil spokesman on health Billy Kelleher earlier described Dr Reilly's actions as “deeply unsettling”, and said it appeared political interference had taken place in the selection process.

"At face value, it appears that political interference has taken place in a selection process that is both of enormous clinical importance and significant commercial value. If this is the case, it must surely be the final straw for a Minister whose 18 month tenure has been a catalogue of disorder, disappointment and dysfunction."

Mr Kelleher said he has asked for the health committee to be convened on Monday to discuss the issue with Dr Reilly. He also called on the Department of Health to publish all details of representations received by GPs and public representatives from the north Dublin area in advance of these locations being added to the HSE list.

Documentation shows that initially some 200 locations were earmarked in order of priority for primary care centres by the HSE. Swords ranked 130th in this list while Balbriggan ranked 44th. The list was later narrowed down to 20 priority locations on the instructions of Ms Shortall.

After the file left her office, a new list of 30 priority locations was sent by the HSE to the secretary general of the Department of Health and a special adviser to Dr Reilly. When the locations were finally announced by the Government in July, the list had been expanded to a total of 35 locations, including Swords and Balbriggan.

The department said last night the final list was changed to bring greater certainty to the successful development of centres. “Experience on the ground in a range of areas has shown that securing the involvement of GPs in such primary care centres can be difficult. The difficulty can be added to in the event that the options of the HSE are limited.”

The Government had now selected 35 potential centres for development with an undertaking to complete 20 of them, the department said. “It is hoped that by this dynamic the interest of doctors in securing the establishment of primary care centres in their area will be enhanced.”

On July 20th last, three days after Dr Reilly announced the list of locations, Ms Shortall wrote saying, “I find it difficult to understand the basis on which the 35 locations which you published on Tuesday were selected.”

In her Dáil speech earlier this week, Ms Shortall said: “Decisions on where primary care centres are located must be transparent and objective, based on health need and no other consideration. Primary care centres, just like schools, are essential public infrastructure and should be provided on the same basis.”

Dr Reilly is involved in a partnership that aimed to build a primary care centre on land near Swords that was purchased in 2007. The three-man group obtained planning permission for the venture and was chosen by the HSE at the time as its “preferred provider” but the agreement was not completed after one of the parties withdrew from the deal.

Dr Reilly told the Dáil last July the project was not being proceeded with and the property was for sale. It remains on the market, his spokesman confirmed last night. The department said the HSE was now examining a proposal to deliver a centre at another location in Swords by leasing accommodation.

Three other sites were added to the final list of 35 locations. Ballaghaderreen was ranked by officials outside the top 200 locations, Kilkenny city was outside the top 150, while Darndale in Dublin was ranked 43rd.

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