2026-04-23

The Minister of State has heard me say many times before that Fingal is the youngest, fastest-growing area in the country. Balbriggan is the youngest large town in the country and the fastest-growing, yet our D-Doc services are appalling. My understanding is that D-Doc was set up in 2006. Obviously, the population of Balbriggan, Skerries, Rush and Lusk, and the rural villages of Garrettstown, Naul, Ballyboughal, Rolestown, Oldtown and so on, have all grown hugely since 2006, yet our healthcare services have not expanded in line with population growth. Census 2022 tells us that the north part of my constituency, Balbriggan, Skerries, Rush and Lusk, and the surrounding villages, has a population of 68,000 people. I have tabled many parliamentary questions for the Department asking what the criteria are to get the expanded D-Doc services, and I am getting no answers back about the criteria. There has been major housing growth and we are continuing to see major housing growth. The reality is that Fingal is the growth engine for housing in Dublin if not the country, yet we have not had the increase in health services, education, public transport, roads or other services that need to go with the delivery of houses. I find it concerning that the HSE service planning is relying on historical data or telling me that what was established in 2006 is suitable in 2026. Something is seriously wrong. Regarding the D-Doc services that are available to us, the parliamentary question response tells me that I can go to Ballymun, Coolock, Hartstown in Clonsilla, which I am not sure I have ever visited before, North Strand Health Centre in Dublin 1, or, the closest, in Swords. The reality is that the Swords D-Doc only stays open Monday to Friday until 11 o'clock and, at the weekends, only from 9.30 a.m. to 10.30 p.m. We simply do not have access to 24-hour healthcare. You absolutely have to have a car to access any of these health services. There is no direct public transport service to them except for Swords which, as I have just said, closes at either 11 p.m. or 10.30 p.m. It is not good enough and I would really like to understand what the Department of Health is going to do to meet demands in the area.

I have to be very careful with this reply because, needless to say, replying on behalf of our mutual dear friend, the Minister for Health, whom I spoke to subsequent to receiving the script, is a balance, because I could throw back to the Deputy many of the points she has raised and somehow that constitutes a reply. I sometimes question, when replies are being drawn up, whether people look at maps or live in the areas. I know where Clonsilla is. I also know where North Strand is. It is a long way from Balbriggan. It should not take a southsider to tell someone that. I could also talk about the responsibility of every GP to make sure they are providing a genuine option for out-of-hours care for their patients as per their contractual requirements and, increasingly, how those out-of-hours services have been developed and expanded over time, and how they are working extremely well in so many parts of the country. It is a real testament not just to the Department, the HSE and the Minister but to the doctors who provide that care. I had reason to be in west Cork just last week and I read the local paper. It talked about a doctor who retired after 27 years of providing out-of-hours care to the sprawl of west Cork. I know Balbriggan is a long way from Stepaside but west Cork is even bigger again. Crucially, it is important to look at the population in the round. The latest population figure for the wider area covered is 690,000. It is covered by five treatment centres, which the Deputy has listed, two of which are only open overnight on weekdays, and those two are open 24 hours on weekends and public holidays. The geography is vast and the requirement for a car is quite obvious. The key thing the Minister would say, which I absolutely agree with her on, is about two things in the immediate area that require attention. The first is the sheer number of GPs in the system. Genuine and forceful efforts are being made on her behalf to make sure we have more general practitioners, both through the additional annual investment and through the conclusion of the GP GMS agreement. Something that we talk about, which is particular to this issue and which is parallel, not the solution, but complementary to it, is to have a greater D-Doc facility that goes into the north county. That is obvious to the Deputy and me, and indeed obvious to the Minister. That is ultimately the direction of travel we are taking, not just because Fingal is the fastest-growing county in the country or that Balbriggan is the fastest-growing area. I remember once when it was Stepaside but obviously it has been overtaken two censuses later. One of the key areas to cover the wider north county area is the development of the Swords surgical hub, which will be operational from this summer. It will draw on and replicate the success of Tallaght and Mount Carmel elective surgical hubs. One is in my own constituency. Indeed, I was born in Mount Carmel hospital. It will implement the use of innovative patient pathways and have a real impact on reducing waiting times for patients. If waiting times for patients are reduced, it means they will have less chance to need that out-of-hours care. Once it is fully operational, that Swords surgical hub is expected to deliver additional annual activity of 8,000 day care procedures based on the four theatres, 5,700 minor operations procedures, and approximately 18,500 outpatient department appointments. The Minister also introduced greater regulations to strengthen that. That is all complementary to the issue the Deputy raised and needs to be addressed at source. Needless to say, I will bring that directly to the Minister following this debate.

I appreciate that. As the Minister of State knows, the surgical hub will be a very welcome addition to the area but it will not deal with the critical issue of the fact that people get sick every time of day and night and need access to a GP. The infrastructure exists in Balbriggan. We have a primary care centre. The population demand is clear. The growth projections are clear. What I am concerned about is that the response to the parliamentary question I received told me there were no plans to expand the GP services in the area. I hope that I am hearing from the Minister of State that the HSE and Minister are open to expanding services. I have been that parent who has had to drive two premature twins to Swords to try to find GP healthcare. The reality is that I did not have access to a car at the time and had to ask a neighbour. That is simply not good enough. We have a huge population in the area. We need to have clear criteria from the HSE and the Department about when we can get a D-Doc service and a timeline for expanding the services, and access to 24-hour GP care.

Out-of-hours GP care is provided to the population in integrated areas. The Government is committed to the continued development of our general practice service to ensure patients across the whole country have timely access to GP services. As mentioned previously, work is ongoing to increase the GP workforce and therefore improve access to both daytime and out-of-hours GP services. Significant investment has taken place in general practice both in the 2019 and 2023 GP agreements but we need to do a lot more. The input from the Deputy makes a very clear geographic case for an increased need to service the wider Dublin Fingal and north county area, with a particular focus on the rapidly growing town of Balbriggan.