Primary evidence

How the lists evolved

1 For over a decade, successive governments have espoused the development of primary care centres to treat patients near home to lessen the pressure on acute hospitals. But progress has been slow, with fewer than 40 centres built and another 300 needed. So the present Government appointed Róisín Shortall as a Minister of State with special responsibility for primary care to speed things up.

2 Shortall got officials from the HSE to draw up a list of all the towns where centres were needed. In her view, the State should take the lead in providing the centres, rather than letting the market decide. She also wanted available resources focused on the areas of greatest deprivation.

The list was ranked in order of priority, according to three criteria – the service needs as assessed by local officials, the accommodation available in an area, and the level of deprivation.

A widely used index of deprivation was employed and on Shortall’s instructions, the weighting attached to deprivation was tripled to further skew results in favour of poorer areas.

The first column shows the 20 priority locations for primary care centres to be developed by public-private partnerships (PPPs) forwarded by Shortall to Reilly in early July. The numbers in red indicate the location’s ranking on the overall list. Primary care centres are to be developed by three methods – built by the HSE under the capital programme, leased from developers, or built as a public-private partnership. A list of the top 200-scoring locations which was finalised by Shortall covered all three delivery methods. First on the list was the country’s most deprived area, Knocknaheeny in Cork, which is due to get capital funding.

3 The first evidence of the list being changed emerges in a Department of Health list from around July 6th. Six locations are added, with Portumna falling off Shortall’s original list.

4 By July 12th, the list now in Reilly’s office had grown to 30 locations, as shown in the third column. The first five additions were ranked relatively highly, but the next 10 come from the lower reaches of the overall list, as their ranking indicates.

5 When the final list is published by Reilly as part of the Government’s stimulus package on July 17th, it has swollen to 35 locations. Late additions include Swords and Balbriggan, both in Reilly’s constituency, and two low-ranking towns in Co Roscommon, Boyle and Ballaghaderreen, which were the subject of lobbying by Government backbenchers in the area.

Reilly says he extended the list to give the HSE more bargaining power in negotiating with the GPs who will occupy the centres, only 20 of which will be built. “If we were to identify only 20, and stick with 20, GPs would then be able to sit back, await their completion and then enter on their terms only,” he told the Dáil. He also says he added new criteria by giving consideration to existing health facilities; GP to population ratio; pressures on services, particularly acute services; funding options, including exchequer-funded, HSE build or lease; and the implementability of a PPP in terms of size, site and scale.