Alex White (Dublin South, Labour) | Oireachtas source

Deputy Kelleher is correct. Colleagues also made the point that these measures are proposed to the Dáil in the context of the necessity to make significant financial savings in the health area. This is where the proposal has come from and I do not for one moment deny that such is the case. Regrettably, there is a need. Colleagues, in particular, Deputy Kelleher, will be aware why that is so and why the economic position is such that we must make savings, including in the health system.

The savings that have been put forward this year in the context of the health budget have been designed as far as possible not to impact on front-line activity and to ensure that the most vulnerable are protected, and that is how the Government has proceeded.

As members will be aware, the GMS is one of the areas that has been identified under budget 2014 for the savings that are required to be made. Over recent years there has been a significant expansion in the GMS scheme. The total cost of GMS services provided to over 70s medical card holders is approximately €750 million per year, which represents over one third of the total cost of the GMS scheme. In circumstances where, regrettably, savings must be achieved, there is no reality to the suggestion that we could not look to this area as providing some of those savings, and that is what we have done.

There are approximately 350,000 individuals aged 70 years and over who currently hold a medical card. It is estimated that the budgetary measure proposed here will move approximately 35,000 persons from a medical card to a GP visit card. In response to Deputy Kelleher, I have not stated that this would have no impact. The Government has not stated that it would have no impact. It would be nonsensical for the Government to state that a measure would have no impact. We have not said so. What we stated is that it will affect one in ten of over 70s medical card holders who are - the term "better-off" is a relative term - the better-off 10% of current over 70s medical card holders. As a consequence, the overwhelming majority of over 70s medical card holders will be unaffected by this Bill.

It would be preferable not to have to make these changes. There is nobody coming in here celebrating this proposal. It is being put before the Oireachtas as a necessary saving, but it will affect only the higher income over 70s, if I may describe them as such, who currently hold a medical card.

I will address this issue that is raised consistently by Deputies Kelleher, Ó Caoláin, Healy and others, namely, that this runs contrary to the Government's plan in respect of universal access to GP care. Deputy Healy made the point that it was at variance with Government policy and that it constituted a roll-back on free GP services for all. It does no such thing because nobody, not a single individual, is losing free access to his or her GP from this measure.

Measures proposed by Government are open to criticism from the Opposition. The Opposition must do its job in that regard. I do not challenge the members in that respect, but we must get the facts straight. It is not contrary to the plan for universal access to GP care without fees because nobody is losing free access to his or her GP as a consequence of this measure because every individual who is moved from a full medical card will have a GP card. There is no separate test, or anything else, for it. It is automatic that any individual who loses out as a result of this change will have a GP card.

The plan is universal access to GP services without fees. That is the proposal that we are bringing forward. That is the proposal with which Deputy Ó Caoláin states he agrees, and I thank him for that. That is the proposal that many think is the correct way to proceed in terms of how we adjust our health care services into primary care, that we do not charge persons for attending their GP. Nothing that we are doing today undermines that. Members should stick to the facts of the matter. There are many other measures for which we can be criticised but we have not taken away free access to a GP from any individual, neither in this measure nor in the measure that we brought in last year. Everybody retains a GP card. There is much that we can debate and much on which we can disagree, but we cannot disagree on that because those are the plain facts of the matter. I would appeal to colleagues to note that such is the case.

On the over 70s who will be affected by this measure, I remind colleagues that under the drugs payment scheme the HSE will meet the prescription drug costs of those persons without a medical card who face drugs costs higher than the DPS threshold of €144 per month. This means that a single person aged 70 with a gross income of over €500 a week or a couple with an income of over €900 a week will have their expenditure on prescription drugs capped at approximately €33 per week. It is true that they will lose out on the free drugs if they move from the full card to the GP card, but they will still have coverage from the DPS, which sees their drugs capped at approximately €33 per week. Those are the facts of the matter.

When Deputy Kelleher spoke earlier about the long-term benefits of universal access to GP services, he made the point about the cost and asked how this could be regarded as a cost when we all are trying to move towards universal access. I welcome his support for universal access to GP services, if that, in fact, is his position. However, as I stated previously in this committee, it will not be possible for us to change overnight a system that we have had for so long which is based on means testing and section 45 of the 1970 Act. We must change this system gradually, particularly given that we face such financial constraints.

We are faced with a situation which, perhaps, is paradoxical. In some ways, maybe it can be described as contradictory that we must make savings in the current system that we are managing but we must look to the future, plan and resource as best we can, even in a modest way, the kind of changes that we need to make a fundamental change to the way the health system is managed and its services are allocated. That is why I support and have brought forward the proposal on universal access to GP care without fees. That is why I say this is not contrary to that. If any of the individuals affected by this measure was losing free access to his or her GPs, the case could be made that the measure would be contradictory to our plan but that is not what is happening.

We are faced with a situation where we must make savings. We are doing that in the best way possible consistent with having to make these savings. It is affecting the top 10% of over 70s medical card holders. They all will still keep their GP cards. They will still have access to the DPS scheme meaning that their drugs will cost no more than €33 per week. It is not contrary to what we are trying to do in terms of the universal roll out. For those reasons, I would commend the Bill to the House.

It is never especially palatable to change eligibility in this way. It is necessary in order to achieve the savings that the Government must achieve. On that basis, I would ask the committee to support it.

On Deputy Healy's point about the doctors, I wish to reassure him, as I did in the House the other day. There have been some complaints raised by the Deputy and others. The HSE has raised this issue with the IMO. The rules are clear. There is no basis for some of the charges that one has heard about.

If somebody requires a blood test as part of the normal diagnostic process, he or she cannot and should not be charged. If it is happening, we need to know about it. We have raised the issue with the IMO. In more general terms, it points to the need for a new contract with doctors. This is another job in which I am very much engaged. In so far as there is a lack of clarity in this area, there should be clarification in a new contract, to which the Government is committed to achieving.