Dara Gantly
Have GPs and developers been given the runaround from the banks over funding new primary care centres, asks Dara Gantly.
The roll-out of primary care teams (PCTs) and the related development of primary care centres (PCCs) have been a central part of health policy since 2001 and while some progress has been made, the whole project has lagged way behind schedule.
Primary care is still central to the new Government’s overall strategy to deliver an integrated and cost-effective health system, and modern, well-equipped, accessible PCCs are the place from which this care is supposed to be delivered. Yet events on March 9 would seem to sum up the mixed fortunes seen across the country and may act as a ‘microcosm’ of why the Primary Care Strategy has stalled. While sods were officially turned that day at the Clonbrusk Primary Care Unit in Athlone — which is expected to be completed by mid-2013 — the private backers behind the proposed Wicklow PCC heard back from Bank of Ireland that it had withdrawn its support.
The 52,000sqft Wicklow facility, expected to be the second-largest PCC in the State after Mallow, has an estimated development cost of €7 million and has been largely pre-let to the HSE and four local GP practices, comprising 10 GPs in total. As reported in last week’s issue of IMT, the centre has full planning permission, is ready to go and only lacks the Bank’s support. The jobs of 100 construction workers may now be lost, along with 150 operational posts.
Minister of State Róisín Shortall believes that the provision of integrated services where the patient can have access to the GP, public health nurses, physiotherapists, occupational therapists, psychologists, dieticians and many other services all in the same building, is the kind of service the public wants and deserves, and it is the ‘way forward’. I think most would agree. Unfortunately the banks don’t seem to have got with the programme.
The Government’s plan for the construction of PCCs would appear to be based on a mixed Exchequer and private funding approach, where State funding would be targeted at disadvantaged areas with the greatest health needs. At one level this seems perfectly sensible, given our economic circumstances, and would be in keeping with Minister Shortall’s Labour philosophy. Yet if funding for the private half of this equation is simply not materialising, does it not call into question the entire project?
Bank of Ireland would not confirm to IMT why it had withdrawn the funding, as it does not comment on the affairs of its customers, and when the story went to press the developers had not received a written indication from the Bank. However, it was believed the problem might have been that the Bank’s quantity surveyor believed the development would cost a few hundred thousand euro more to construct than envisaged by the client’s quantity surveyor. But as the developers are understood to have already raised other sources of revenue to compensate for a portion of this shortfall, should such a strategically important [my italics] development fall at such a surmountable hurdle?
Even local FG TD Andrew Doyle believed there was an obligation on the pillar banks to fund these exact projects, particular if they were receiving European Central Bank funding at minimal costs of 1 per cent
Those behind the Wicklow PCC want the Government to take action. Local builder Jimmy Esmonde, MD, JEN Properties, said there was no point in the Government having a strategy if this was not being supported by the pillar banks, which in turn, he pointed out, had been bailed out by the local people of Wicklow. Pat Nolan, Director with the property, healthcare and project management company Feasible, added that the project could prove a true test of the Government’s mettle and commitment to job creation, its own health strategy and its control over the banks.
Even local FG TD Andrew Doyle believed there was an obligation on the pillar banks to fund these exact projects, particular if they were receiving European Central Bank funding at minimal costs of 1 per cent. But there lies the problem.
Last week, an article in The Irish Times highlighted that tracker mortgages — the darlings of the Tiger era boom — now account for 60 per cent of Permanent TSB’s €26 billion Irish residential mortgages, 54 per cent of AIB’s €27 billion book, 23 per cent of the €16 billion book at its subsidiary EBS, and 62 per cent of Bank of Ireland’s €28 billion book. Some of these may be breaking even, but most are apparently heavily loss-making. It would appear the banks now need something done with these loans in order to free-up lending again.
But if the private sector cannot develop these primary care centres because the Government is effectively not leaning on the banks to support its strategy, are we all just wasting our time here? Ireland urgently needs 200 PCCs to take the pressure off our hospitals, reduce costs to the State, deliver chronic disease management in a PC setting, and implement the 2001 Primary Care Strategy. Where the funding will come from remains up in the air.