John Crown (Independent) | Oireachtas source

I welcome the Bill, notwithstanding the genuine concerns which prompted me to bring forward the series of amendments we have discussed. It is important to consider the context in which these provisions are being introduced. As we know, a draft contract was circulated to GPs earlier in the year. One could argue that this did not represent the Government's final position but was essentially the first salvo in the negotiating process. Even if that is the case, however, the inclusion of a gagging clause must give cause for wonder as to what kind of message the Government was hoping to send. My amendment No. 1 serves to remove that provision, which corresponds to section 28.4.4 of the draft agreement, specifying that service providers shall do nothing to damage the reputation of the HSE.

GPs have also expressed concern that the Bill seems to be transferring a number of new services to them - services which traditionally were fulfilled by other parts of the health service - without adequate consultation. There are specific concerns regarding public health nursing, for example, and the impact of the introduction of new screening and diagnostic technologies. The more general concern is that GPs might find themselves effectively in the position of a basket or holdall group because they were corralled into signing a very broad, general contract. In other words, the fear is that any development in the health service could, without any further negotiation, be put on the door of GPs.

The GPs I know want to see the introduction of universal coverage for general practice health care. They would prefer to see it done in a post-austerity environment, as soon as the national emergency is resolved, and on the basis of need rather than purely on the basis of age. I have the sense they were not opposed to this Bill because of the proposal for free GP care for under sixes but because they were concerned about some of the implications of these provisions, in particular the attempt to impose a gagging clause and the potential for the legislation to be used as a type of basket negotiating position for further services, as yet undetermined, without putting any effort whatsoever into ensuring GP services are adequately resourced.

I made the point to the then Minister of State, Deputy Alex White, last week - I am sure the Minister of State, Deputy Kathleen Lynch, will agree with me - that general practice is the least dysfunctional part of our health system. It is a service within which all patients, whether public or private, see the same doctor, are placed on the same waiting list, attend the same waiting and consultation rooms and will, with the exception of certain treatments which may or may not be made available by the HSE under the general medical services scheme, be given the same level of treatment. This is not something we should be seeking to threaten, corral or overburden. Instead, we should be holding it up as an example for the way the rest of the health system should work.

We have a new health administration. I would like to pay tribute to the efforts of the former Minister for Health, Deputy Reilly, who made honest efforts to launch the health system on the path of genuine reform for the first time. The obstructions and the delays he encountered did not come from the health care professions but from behind his back. It is sad for me that everybody on the other side of this Chamber and the other House knew the policies they were adopting in 2011. They knew they were assuming a package of austerity-based policies. I am not going to recite the arguments concerning bank guarantees and macroeconomics, because they have been done to death already, but people knew what they were voting for. What happened over the past year was entirely consistent with those austerity policies. What happened with medical cards was always going to happen when people voted for those measures. I think it was cynical beyond belief to try to victimise one or two political figures who actually did what the massed ranks of their two parties told them to do. When the votes in the local and European elections went the wrong way, it was somehow as though there was a unique level of responsibility devolving to these people for doing what they were told. I think it is unfair and I wish to put it on record in respect of the then Minister for Health, Deputy Reilly, and also the then Tánaiste and Minister for Foreign Affairs and Trade, Deputy Gilmore.

With the new dispensation, we have the chance to look forward to what the new Minister for Health, Deputy Varadkar, and his Minister of State, Deputy Lynch, will do. They will be a formidable, forward-looking, clever and potentially radical reforming team. This is the chance to reform our health system, which is full of dysfunction. This very day, when I was making inquiries about why a huge chunk of elective surgery in my own hospital appears to have ground to a halt - we have already discussed the issue of anti-obesity bariatric surgery in this House - a wholly unrelated area emerged. When I was trying to work out exactly who was making the decision that a certain procedure should be put on to such a long waiting list that it was effectively being suspended, the clinicians came to me rather timidly and said they were not very happy about being quoted in public in a way that made them appear to be criticising their institution, and they would prefer if I did not talk about it. This is the culture that the Minister of State, Deputy Lynch, and the Minister, Deputy Varadkar, must deal with. There is a culture which is inimical to dissent, disclosure and to whistleblowing. Such advances as did occur in the health service in the past decade in areas such as cancer care had their origins in the fact that there were people who were prepared to stand up, speak out, point out deficiencies and point fingers where they needed to be pointed.

As we go forward, it will be critically important that we look at the model of universal health insurance - a socialised model of uniform health care - under which different people will pay different levels of premium but will all get the same freely negotiable insurance instrument. They will have the choice of going to a hospital run by the State, a hospital run by a university or a hospital owned by a for-profit corporation, locally or internationally. There are a number of different ways in which this could be done. People may go to doctors who have different kinds of contracts, some in full-time paid employment of the State, some as independent contractors and some working as university academics. This is the ultimate logic of the model, and there are many people surrounding the Minister of State and the Minister who will not like it. They may say they like it but they do not, because there is a colossal transfer of power to the consumer when this type of model is introduced, away from those who rule the health system by fiat. I believe that is the central challenge that the Minister will have to address.