Martin Daly: Calls for state-led primary care where lease model fails
Martin Daly addressed the Health Committee, thanking the outgoing HSE official and reviewing a recent report on population ageing, unscheduled care and primary care provision. He criticised inconsistencies in unscheduled care, highlighted waiting-list movements, and urged state-led capital where lease models do not meet community needs.
Opening remarks and acknowledgment
He opened by recognising the departing HSE official's service and transparency, thanking the team for appearing before the Health Committee and wishing the official well in retirement. Daly framed the discussion around an ageing, more informed population with rising comorbidities and expectations of the health service.
Unscheduled care performance and regional variation
Daly said unscheduled care demand has accelerated, especially following flu season, and that regional patient-flow systems create inconsistency. He contrasted Dublin North East's consistent trolley performance with the West's unpredictable unscheduled-care outcomes, and noted a national team had been sent to the West for three days and a workshop with the Minister was scheduled.
Waiting lists and scheduled care pressures
He noted scheduled-care figures: while 1.8 million people were removed from waiting lists, 1.928 million were added, describing this as a considerable challenge for health-service capacity. He framed these statistics as evidence of sustained pressure on services rather than a political critique.
Primary care delivery models and state investment
On primary care, Daly recalled past models and said the lease model has delivered well in many places but can fail some communities. He argued that where the lease or developer-led approach does not provide timely facilities, the state should consider direct capital investment to build primary-care centres, citing Donegal's earlier primary-care centres as successful examples.
Local examples and patient experience
He brought the debate to individual impact, recounting a self-employed mother who returned from Australia and spends about €4,000 on private health insurance to secure cover for her family while also facing high childcare costs. He used this example to emphasise how national policy decisions affect people in towns such as Balahadrin and communities with high deprivation and linguistic diversity.
Doctor visit card uptake and next steps
Daly raised concerns about poor uptake of the doctor-visit-only card and asked for insight from colleagues with responsibility for that scheme. He said the Minister is not wedded to a single delivery model for infrastructure and is willing to consider alternatives when communities are not served adequately.
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I just want to say and recognise your last appearance here in front of the Health Committee. I want to recognise your service to the HSE and to public health in Ireland. And I want to say in all my dealings with you in my previous life as an IMO advocate and hear your honesty and transparency in all dealings with you. You're a very straight man and I wish you well in your retirement, long life and health and happiness. Thank you. I just reflect on the report and thank you for your team for coming in here today. We appreciate that. You know, the reflection, the report of a population getting older, more comorbidities, a rising population, a more sophisticated population, well-traveled and also informed by their experiences of other health services around the world and expecting more from our health service. And just to reflect the meeting I had yesterday with a self-employed mother of three children in Banlaslo, who had come back from Australia 12 years ago and is hard-pressed to spend €4,000 on private health insurance because she feels she needs that to give her family cover in addition to quite expensive childcare. So that's the context we talk about services. We have to bring it down to the individual people. I noticed, and I'll try and keep the questions short and direct, and I think they can be, you reference on unscheduled care that there's a lack of consistency around the country in terms of some of the wait times for people in emergency rooms and that. Could you just reflect on that briefly, Theo? Sure. Absolutely. And I can do it as recently as this weekend. I was on all weekend because obviously we're coming off the back of an accelerated growth in demand plus the back of the traditional flu season. And when I look at how the demand for unscheduled care presses on every region, some more than others, but it presses in every region, and I look at how regions have changed to manage their patient flow systems, that's where the lack of consistency arises to me. And look, people in regions will argue about history, resources and different things, and all of those are factors, but they affect everybody. It happens to be that the regional executive officer for Dublin North East is here with me today. Dublin North East is now a region that has achieved one of the most consistent performances inside its green marker threshold for trolleys. And when a site goes red like the matter did on Tuesday, it recovers very quickly, and that's a very consistent. Whereas when I go to your own region, it's quite an unpredictable scenario. It's very difficult to predict with any certainty the unscheduled care performance in the West. It is something I'm quite concerned about. I am meeting them with the Minister next week in one of those scheduled workshops, and I have a national team gone to the West today for three days to help me form a more deeper view. It's something the Minister has reflected upon publicly, so I'm not trying to target anyone here. No, no, but there's a reality of experience for the people in the West-Northwest. To learn from other parts of the organisation nationally, because obviously a significant amount of effort has gone into the management of unscheduled care in other parts of the country, and we should have the same level of efficiency in the West and Northwest. It's just a reflection, and I appreciate your answer. I fully agree. And I also noted on, you know, it is a bit like a sinking ship at times. I noted for scheduled care that in spite of 1.8 million people removed from waiting lists, we saw 1.928 million people added to that. I mean, that is a considerable challenge for our health services in terms of our capacity to respond. So just moving on, that's more of a statement. I accept what you've in there in the thing. In primary care, we have in our area, in Roscombe and Galway, Balahadrin, you know, a town with significant challenges in terms of poverty and deprivation. In the national school there, they have 22 different languages spoken. They were promised a primary care centre for a long number of years. Could you reflect again, I asked this question before, on the model of developer-led primary care provision? I mean, should it not be the purview of the state to provide these bills directly? Yeah, so I was around when we had no developer-led model, and we built health centres, as we called them then. I've been around for the PPP model, which I think gave us an amount, but it wouldn't be a model I favour. However, the lease model has delivered well in many parts of the country, and I'm glad to see that, and we're going to continue to pursue it this year. I do think the policy question that arises, and I know it's one the Minister is reflecting on, when the lease model simply does not give a community what it needs within a reasonable time frame, the state should consider proceeding to direct capital, build an investment. That would seem to me to be the best position, yes. I'm old enough to remember the first batch of primary care centres in Donegal especially. For some reason, Donegal built a number of them in the north-west, and they were very successful models. I just think that in communities where there's significant need, that the state should be taking the lead role in providing those centres. I certainly know, and while the capital plan has many demands, I certainly know from my most recent discussions with the Minister, she's not locked into the developer model solely. She wants to see the infrastructure for the communities, however it's achieved. Because I just feel that Balahadrine has been failed by this model, and that's not, it's the model that has failed. No, no, I wouldn't dispute that. The doctor visit only card scheme, why is there such a poor uptake? I might ask Pat, who is deeply sought in that, to give an insight. It's actually difficult to see, because there are people who should be taking it up. What we've tried to do with the department and the HSE, we've done significant communication campaigns. We've also focused on our own PCRS system of making it as simple as possible for people to apply. And we have another campaign going on that this year, so there is an issue about encouraging everybody. Have we profiled the type of people who aren't taking it up? I can see families taking it up. Is it single people who are working, who are on low incomes, who don't see the value? It appears to be a mix, but definitely most single people are part of that, and younger single people. Male, younger single people, but what we've been doing then is we've done quite a bit in terms of research to try and target and go out and research why and who. What capacity do we have? I'm sorry, I'm on a, Mr. Healy, I'm on a tie. How many cards, what capacity is there to be delivered if everyone took up the entitlement? Well, between medical card and GP visit card. No, just GP visit card. Yeah, like we have 700,000 at the moment. But off the cohort that were the additional amount, was it 350,000 extra? That's right, we haven't reached that, we haven't reached 50,000. 50,000, 60,000? Yes. So it's a pretty poor uptake. It would be important to try and have an idea of why that has happened. That's not an attack or anything, but we should learn from it as the reasons why someone wouldn't take up what is a valuable entitlement to primary care. On the breast cancer piece, I'm happy to see that 95% of women are offered urgent breast cancer assessment, if marked urgent, within two weeks. One of the issues that's arising in the West is, in West-Northwest, from a number of representations, is an interval, a lengthening interval between a diagnosis of breast cancer after assessment and the offer of treatment. And I wonder if you could reflect on that. I'll just get a quick answer on that, because we're running on time, so briefly. The whole breast screening treatment pathway, because as you know, Deputy, the screening identifies women who then need timely treatment. So there has been some delays in some areas, and part of the remit of the National Cancer Control Programme in 2026 will be working with the Regents to ensure the end-to-end pathway is delivered in a timely way, consistent with a screening program. Thanks, Mr. Henry. Thanks. Thank you.
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