James Reilly (Dublin North, Fine Gael) | Oireachtas source

I did not quite catch that comment, but I got a sense of it.

At the end of November, 1,983,572 people in this country were in possession of either a medical card or a GP visit card. In fact, the numbers in receipt of both have risen by 500,000 in recent years. In other words, more people than ever have access to GP care under the GMS scheme. I am engaged in discussions with the Minister of State, Deputy White, regarding a new GP contract not just in respect of patients aged under six years of age, but in the context of the overall spread of free GP care at the point of delivery. Nobody is pretending that this type of provision will not be costly, but it is a question of ascertaining how we can best achieve value for money. In many cases, patients' needs can best be met by their GPs, and the local practice is usually the most convenient location and closest to home for patients.

As it stands, we have doctors doing work that nurses could be doing, nurses doing work that health care assistants could be doing, and consultants doing work that allied health care professionals could be doing. I have referred on numerous occasions to the screening that is being done by physiotherapists of referrals to orthopaedic surgeons, which has resulted in 50% of patients not needing to be referred because they can be dealt with by the physiotherapist. In the area of mental health, for example, GPs whose patients require counselling but cannot afford to avail of it privately are obliged to refer those patients to a psychiatric clinic. The psychiatrist's time is being taken up to refer such patients to the counselling service in the public sector. That is utter madness. These types of practices need to change, and that is what we intend to do. I see a much greater role for nurse practitioners and a much larger number of same working in a new model of general practice, where chronic illness prevention and care will be a major feature and where nurses can screen the patient to see whether they need to consult the doctor. If we keep doing things the way they have always been done, we will keep getting the same results. Changing that is a major part of our planned reform of the system.

There has been a great deal of concern in regard to the provision of medical cards. The reality is that no medical condition ever entitled a person to a medical card; provision was always by reason of financial hardship. Clearly, many illnesses and conditions create financial hardship for citizens. There is no question about that. However, instead of looking to the medical card, which has strict rules attached to it, effective change requires legislation and is a policy issue on which I have not thus far received a directive from Government. Nobody in this room wants to see any person experiencing hardship or those with life-long conditions being further disadvantaged. I have asked the Health Service Executive to put together a small review group to examine how we can best meet the needs of these people. It is about finding a different approach and examining what supports are required.

In regard to nursing home treatment and medical cards, I do not want to be adversarial but the issue of nursing home care and the additional care given under that system was always problematic in the past. It is an issue we are examining. For example, we are in discussions with the HSE regarding methodologies for getting allied health care professionals out into the field. We have fine young men and women who, having studied very hard to achieve 555 points in their leaving certificate, go on to spend four years studying physiotherapy in Trinity College and elsewhere. These young people are very well qualified but do not have sufficient experience to go out on their own into the community. Some of them end up working in McDonald's or leaving the country. We are considering an initiative whereby these graduates could avail of an intern year that would give them the work experience to be able to go out into the communities where they are so badly needed. As a GP of 30 years' experience, I would be very keen to have a physiotherapist attached to my practice. In some cases, for instance, it might not be necessary to send a patient for an X-ray because the physiotherapist can deal with the problem. When the facility is there, people will use it.

I thank Deputy Ó Caoláin for his support for the cochlear implant fund. It is very much our intention that no child should turn seven years of age without having received the bilateral implants he or she requires. After that age, the opportunity is lost for these children. We are having to play catch-up in this area in the same way as we did with the cervical cancer vaccine. Our plan is to ensure that no child loses out and none is prevented from achieving normal hearing where that is possible.

In respect of the Deputy's concern regarding the Statute of Limitations as it relates to those women who underwent symphysiotomies, the Attorney General's advice is very clear that to make a change in this instance would have all types of ramifications and unforeseen and foreseen consequences. As such, she is completely opposed to what the Deputy has outlined. In the case of many of the women who have suffered so much as a consequence of this procedure, the person who carried out the operation is deceased. Some of the women do not even know the name of the doctor who performed the procedure on them. They have no access to medical notes because those notes are gone. Many will incur huge cost and endure enormous delay by taking their case to court.

If we change the Statute of Limitations, the insurers will state that we have changed the game and that they have no further culpability. I wish to place on record the fact that we are not letting the insurance companies off the hook on this matter. They have an obligation in this area and the State will play its part too.

There are some specifics to which the Deputy referred as occurring at the meeting. The Minister of State, Deputy Kathleen Lynch, was present at that meeting with me. I do not have the contemporaneous notes from that period but I do know that I did not determine what would be the scale of awards.