I, too, welcome Cara and Mark to the Public Gallery today. I will be speaking about the issue that concerns them later in the day. It is a scandal that Cara has to be here again to protest on the issue.

The issue I want to raise with the Taoiseach is the absence of primary care. It is over eight years since the Sláintecare plan was agreed for a public health system by all parties in this House. It was due to be fully up and running by the end of this year, by 31 December, but, of course, we are so far from the full implementation of its recommendations and what was set out in it. Nowhere is this more starkly seen than in the area of primary care.

Primary care is sparse right throughout the State, particularly in County Laois. Despite the best efforts of GPs and staff working in the sector across the State, we are not within a country mile of having a properly resourced and fully functioning primary care system. The effects of this are many. There is a lack of timely intervention and minor health issues are becoming chronic, finishing up in hospitals. We have emergency departments clogged up with people who cannot afford to go to a GP because they do not have a medical card. In some cases, they cannot get a GP even when they have a medical card or are going privately. On occasion, people who come to me state they cannot access a GP even though they are paying privately.

Treatments that should be available in primary care centres and local health centres are simply not available. Therefore, it is up to the hospital, which is where people are going. Basically, we have to have health centres and GPs to staff them, in addition to ancillary staff, whom we do not have in this country, to manage and man them and ensure the services are available.

In County Laois, we are short of the basics on both counts. We have no primary care centre in Portlaoise, a town with a population that exceeds that of Kilkenny. It now has a population in the region of 30,000. We have health centres in Mountrath, Borris-in-Ossory, Rathdowney and Graiguecullen that need to be replaced or upgraded. In the case of Portlaoise, the design is done but the project requires capital funding to move it on. It is located on a perfect site. The centre in Mountrath is too small and is outdated. It is being talked about but the project needs to be moved on. It is the same for the centre in Rathdowney, which is totally unsuitable. A new centre needs to be put in place there. We are moving at a snail’s pace. The centre in Borris-in-Ossory needs to be replaced, and there is now an opportunity to locate it within the old courthouse, which is being refurbished by the county council. In Graiguecullen, the position is the same. There is talk of making it the health centre for the south-east corner of Laois, taking in Swan, Newtown, Crettyard, Killeshin and Arless. However, this cannot happen because, as things stand, we cannot even cater for the population of Graiguecullen.

I thank the Deputy. I call the Taoiseach to respond. Deputy Stanley will have a chance to come back in.

Will the Government start resourcing primary care in County Laois and other counties?

I thank the Deputy very much for raising the issue of the crucial importance of primary care provision. When I was Minister for Health and Children in 2001, we made primary care the cornerstone of the then health strategy, Quality and Fairness. It took some time. In the modern area, we have progressed fairly significantly in terms of the provision of primary care centres. There are now about 179 of them across the country, 50 of which have been opened since 2020.

Overall, the Government is delivering record levels of investment in health services. A record €25 billion has been made available for 2025, and that represents an increase in health funding since 2019 of over 70%. In parallel with primary care, it supports very important initiatives like enhanced community care, and it also supports oral health and palliative, cardiovascular and cancer care.

Sometimes people say health absorbs an awful lot of expenditure and ask if we are pouring all the money into a black hole. We are not, actually. Outcomes are improving all 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 member states where that is the case. Our mortality rate fell by 11% over the years 2014 to 2022. The mortality rate for all circulatory system diseases fell by 20% in that period, with heart disease and stroke falling by 28% and 37%, respectively. A lot of that was due to the work on primary care in terms of cardiac initiatives in particular. The mortality rate for all cancers in that period dropped by 15%, with cancer of the trachea, bronchus and lung and breast cancer dropping by 21% and 22%, respectively. The mortality rate for all respiratory system diseases has fallen by 15%, with chronic lower respiratory diseases and pneumonia falling by 9% and 41%, respectively.

We are making progress in terms of investment in health and, critically, health outcomes. There are other aspects of that - healthy lifestyles, nutrition and so on - but primary care is central to it. As regards chronic disease and chronic disease management, for example, primary care is where it is at. Some 95% of GPs are now signed up to the chronic disease management programme, with over 645,000 patient reviews by GPs in 2024 alone. Some 92% of patients with chronic disease are now fully managed routinely in primary care and not attending hospital for the management of their conditions.

From what the Deputy has said, I would say progress is happening in his constituency. I think he said that in Portlaoise the design stage is complete for the primary care centre and he has said it is an excellent site. I anticipate progress in that regard. I will check with the Minister-----

Money.

-----and the HSE in respect of the capital requirements for that. I hear the Deputy loud and clear. This is an important centre of population that requires a primary care centre.

I thank the Taoiseach for his reply, but we also need GPs. Mike O'Callaghan of the Irish College of General Practitioners said that we clearly have a deficit in our GP numbers and he listed out a number of counties, including Laois. The last time I checked, we were way below what is required. Primary care centres and health centres in other countries include a whole range of services - physiotherapy, occupational therapy, dental, chiropody, mental health services, etc. - but we are miles away from that comprehensive primary care model. We have neither the staff nor the facilities. I agree with the Taoiseach that primary care is the cornerstone. He said 79 primary care centres have been funded.

I said 179.

Will his Government commit to the capital funding needed to construct a new primary care centre in Portlaoise? The site and the design are there. Will the Government provide the funding for new health centres for Mountrath and Rathdowney and upgrades in Borris-in-Ossory and Graiguecullen? Will the Government increase the number of GPs per county? There is a commitment in the programme for Government to explore the recruitment of HSE-employed GPs. We need to go further than exploring it; we need to do it. The programme for Government states, "Explore the recruitment of HSE-employed GPs." We need to start employing a cohort of those also.

I said there are 179 primary care centres now in place. Of those, 50 have opened since 2020. I take the Deputy's point that we still need more GPs. The outgoing Minister for Health, Stephen Donnelly, had approved, with the outgoing Minister for higher education, now Tánaiste, additional places in all third level colleges in respect of medicine and also, in terms of nursing and so on, in Northern Ireland. In terms of the specifics, we also have programmes to attract people into rural Ireland and to provide greater cover in rural Ireland through rural GP programmes. We fully accept the challenges that are out there. I will inquire about Rathdowney and other locations in County Laois and, critically, the status of the Portlaoise project. We are committed to primary care and we will continue to expand primary care.