Brian Stanley criticises primary care shortfalls in County Leish
Brian Stanley addressed the Taoiseach about the absence of primary care, calling the situation a scandal and demanding urgent resourcing for County Leish and other counties. He detailed missing and outdated primary care facilities in Port Leish, Mount Thrat, Burris Nostrid, Rat Downey and Great Cullen and warned that patients are ending up in overcrowded hospitals.
Brian Stanley said Port Leish, a town with a population now in the region of 30,000, has no primary care centre despite a completed design that requires capital funding. He described Mount Thrat and Rat Downey centres as too small or totally unsuitable and called for replacement or upgrades. Burris Nostrid was identified as a site that could be relocated into the refurbished old courthouse, and Great Cullen was discussed as a proposed centre for the south-east corner of Leish covering Swan and Newtown, Crettiard, Colition and Arles but currently unable to cater for demand.
Stanley warned that the sparse primary care provision is causing lack of timely intervention, turning minor health issues into chronic conditions and pushing patients into emergency departments. He said people are attending hospitals because they cannot afford a GP without a medical card or cannot access a GP even when paying privately. He also emphasised shortages of GPs and ancillary staff needed to run health centres.
The Taoiseach thanked the Deputy and recalled that primary care was made a cornerstone of the health strategy. He said there are about 179 primary care centres nationwide, with 50 opened since 2020, and cited a record 25 billion in health investment in 2025 representing an increase since 2019 of over 70%. He pointed to improving outcomes - life expectancy above 82, an 11% fall in overall mortality between 2014 and 2022, a 20% fall in mortality for circulatory diseases with heart disease down 28% and stroke down 37%, cancer mortality down 15% (with trachea, bronchus and lung and breast cancers down 21% and 22%) and respiratory disease deaths down 15% (chronic lower respiratory diseases down 9% and pneumonia down 41%).
The Taoiseach noted that 95% of GPs are signed up to the chronic disease management programme, with over 645,000 patient reviews by GPs in 2024 and 92% of patients with chronic disease now routinely managed in primary care. He said he would check with the Minister and with the agency in respect to the capacity and progress for the Port Leish primary care centre and related local projects.
Primary care shortages in County Leish
Brian Stanley said Port Leish, a town with a population now in the region of 30,000, has no primary care centre despite a completed design that requires capital funding. He described Mount Thrat and Rat Downey centres as too small or totally unsuitable and called for replacement or upgrades. Burris Nostrid was identified as a site that could be relocated into the refurbished old courthouse, and Great Cullen was discussed as a proposed centre for the south-east corner of Leish covering Swan and Newtown, Crettiard, Colition and Arles but currently unable to cater for demand.
Impact on hospitals and patients
Stanley warned that the sparse primary care provision is causing lack of timely intervention, turning minor health issues into chronic conditions and pushing patients into emergency departments. He said people are attending hospitals because they cannot afford a GP without a medical card or cannot access a GP even when paying privately. He also emphasised shortages of GPs and ancillary staff needed to run health centres.
Government response and national health outcomes
The Taoiseach thanked the Deputy and recalled that primary care was made a cornerstone of the health strategy. He said there are about 179 primary care centres nationwide, with 50 opened since 2020, and cited a record 25 billion in health investment in 2025 representing an increase since 2019 of over 70%. He pointed to improving outcomes - life expectancy above 82, an 11% fall in overall mortality between 2014 and 2022, a 20% fall in mortality for circulatory diseases with heart disease down 28% and stroke down 37%, cancer mortality down 15% (with trachea, bronchus and lung and breast cancers down 21% and 22%) and respiratory disease deaths down 15% (chronic lower respiratory diseases down 9% and pneumonia down 41%).
Primary care programmes and next steps
The Taoiseach noted that 95% of GPs are signed up to the chronic disease management programme, with over 645,000 patient reviews by GPs in 2024 and 92% of patients with chronic disease now routinely managed in primary care. He said he would check with the Minister and with the agency in respect to the capacity and progress for the Port Leish primary care centre and related local projects.
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Transcript
Thank you. I want to also welcome Cara and Mark to the public gallery today. I will be speaking on that issue later on in the day. It is a scandal that you have to be here again to protest on this issue. The issue I want to raise with you Taoiseach is the absence of primary care. It is over eight years since the launch of care plan was agreed for a public health system by all parties in this house at the time. It is due to be fully up and running by the end of this year, by the 31st of December, but of course we are so far away from the full implementation of its recommendations and of what was set out in that plan. Nowhere is this more starkly seen than in the area of primary care. The sparse nature of it right throughout the state, and particularly in County Leish. Despite the best efforts of those GPs and staff working in the sector across the state, we are not within a country mile of having a properly resource and fully functioning primary care system. The effects of that are many, lack of timely intervention, where minor health issues become chronic cases and finish up in hospitals. We have emergency departments who are clogged up with people who cannot afford to go to a GP because they do not have a medical card, or in some cases they cannot even get a GP, even when they have a medical card or even when they are going privately. I have people that come to me on occasions and even when they are paying privately they cannot access a GP. And treatments that should be available in primary care centres and in local health centres are just simply not there. So it is off to the hospital, that is where people are going. The basics are that we have to have health centres and GPs to staff them, and the ancillary staff, which we do not have in this country, to manage them, to man them and to make sure that the service is there. And in County Leish, we are short on both counts of the basics. We have no primary care centre in Port Leish, a town with a population which is exceeding the city of Kilkenny, it is a population now in the region of 30,000. We have health centres in Mount Thrat and Burris Nostrid, Rat Downey and Great Cullen, that need either replacement or upgrade. In the case of Port Leish, the design is done, but it requires capital funding to move it on. It is on a perfect site located. Mount Thrat, the centre of the stairs is too small, it is outdated, it has been talked about, but it needs to be moved on. Rat Downey is the same, totally unsuitable, and that needs to be progressed to put in place a new centre. But removing a snail's paste, T-Shot. Burris Nostrid needs replacement, and there is an opportunity there now to locate it within the new courthouse, sorry, within the old courthouse that has been refurbished by the County Council. Great Cullen, the same, there is talks about making the health centre for the South East corner of Leish, taking in to Swan and Newtown, Crettiard, Colition and Arles. But this cannot happen, because as things stand, they cannot even cater for the population of Great Cullen. So will you start resourcing primary care in County Leish and other counties? First of all, I thank the Deputy very much for raising the issue of the crucial importance of primary care provision. Indeed, when I was Minister for Health, we made primary care a cornerstone of the then health strategy at the time in 2001, quality and fairness. It took some time, but I think in the modern era, we have progressed fairly significantly in terms of the provision of primary care centres. There are now about 179 primary care centres across the country, and 50 of those have been opened since 2020. And overall, the Government is delivering record levels of investment in health services. A record 25 billion in 2025, and that represents an increase in health funding since 2019 of over 70%. It also, in parallel with primary care, supports very important initiatives like enhanced community care, and in terms of oral health, palliative care, and obviously cardiovascular and cancer care. Sometimes people say health absorbs an awful lot of expenditure, and are we pouring all the money into an empty sort of blackboard? We are not, actually. Outcomes are improving all of the time, and that needs to be acknowledged as well. Life expectancy is now above 82. We are in a small group of seven EU members states where that is the case. Our mortality rate fell by 11% over the decade 2014 to 2022. The mortality rate for all stroke relief system diseases fell by 20% in that period, with heart disease and stroke falling by 28% and 37% respectively. And a lot of that was due to the work in primary care, in terms of cardiac initiatives in particular. Mortality rate for all cancers dropped by 15%, with cancer of the trachea, bronchus and lung and breast cancer dropping by 21% and 22% respectively. And mortality rate for all respiratory system diseases has fallen by 15%, with chronic lower respiratory diseases and pneumonia falling by 9% and 41% respectively. When I say all of that, we are making progress in terms of investment in health and critically in terms of health outcomes. There are other aspects of that, healthy lifestyles and nutrition and so on. But primary care is central to it. And we will, you know, in terms of chronic disease, for example, chronic disease management, primary care is where it's at. And 95% of GPs are now signed up to the chronic disease management programme. And over 645,000 patient reviews by GPs in 2024 alone. And 92% of patients with chronic disease are now fully managed routinely in primary care and not attending hospital for managing their condition. Now, I'd say by what you have said, progress is happening in your constituency. I think Port Leach, you said the design stage is complete for the primary care centre. And you said it's an excellent site. So I would anticipate progress in that regard. I will check with the Minister and with the agency in respect to the capacity requirements for that. But I hear you loud and clear. And it is an important centre of population that does require the primary care centre. Thanks, Tisha, for your reply. But also we need GPs. Mike Callaton of the Irish College of General Practitioners, he said that we clearly have a deficit in our GP numbers. And he listed out a number of counties including Leash and that. And the last of my cheque, we were way below what's required. Primary care centres in other countries and health centres include a whole range of services, physiotherapy, occupational therapy, dental, chiropathy, mental health services, etc. But we're miles away from that comprehensive primary care model. We neither have the staff nor the facilities. I agree with you that primary care is the cornerstone. So will your government commit to, and you said 79 have been funded primary care centres, so will your government commit to the capital funding needed to construct a new primary care centre in Portlaoise, the site is there, the design is there, and new health centres from Mount Rath and Rath Downey, and upgrades of Burris Nostry and Grey Cullen. Will you provide the funding for that? And will you expand and increase the number of GPs per county? There's a commitment in the programme for government in relation to expanding and exploring the number, it says explore the recruitment of KHSC-implied GPs. We need to go further and explore it. We need to do it. It says explore the recruitment of HSE-implied GPs. We need to start applying a cohort of those also. Thank you. First of all, there are 179 primary care centres now in place, as I said, 179, and 50 of those have opened since 2020. And I take your point. I mean, we do still need more GPs. So the outgoing Minister for Health, Stephen Danley, had approved with the outgoing Minister for Higher Education, additional places in all third-level colleges in respect of medicine, and also in terms of nursing and so on in Northern Ireland. But in terms of the specifics, we have programmes also to attract people into rural Ireland and to provide greater cover in rural Ireland in terms of rural GP programmes. And we fully accept the challenges that are out there. And I will inquire in respect of Rathdowney and other locations within County Leash, and also critically, the status of the Port Leash project. Thank you. But we are committed to primary care, and we continue to expand primary care. Thank you, Taoiseach. And that concludes...