Alex White (Dublin South, Labour) | Oireachtas source

Deputy Kelleher made some observations and asked some questions about primary care. I am aware of the issues that have been raised at various meetings organised by general practitioners around the country. I am fully aware of the concerns people have raised and I am in regular contact with general practitioners as a Deputy as well as a Minister of State. I have visited general practitioners in their practices and have met them in my office, and am fully aware of the issues they have raised.

A considerable amount of the concern GPs have is not related to the provision for those under the age of six. That is perhaps in some ways a proxy or the occasion for these issues being raised rather than the reason they are being raised. I can see the concerns people have, particularly after the period we have come out of. There are people in general practice who have made commitments in some cases who are struggling in many situations in common with many other people across society who have come out of a huge economic collapse. This has also affected GPs who are also citizens and who have seen their material circumstances decline, significantly so in some cases. That is the case across the board. It is certainly the case across the public service. There is no public service worker who has not had their pay reduced. Similarly, GPs have had to face that as well. Of course, they are providing an essential public service for citizens.

Despite the concerns raised by GPs, which I take seriously and understand, they are continuing to provide a highly efficient and professional service in general practice in rural and urban areas across the country because I have seen it for myself. One could not criticise the level of service. I know colleagues have been contacted by GPs, as have I, but I do not get a sense from the people that they are getting less of a service. I am not infallible and there may be cases of this but that is not the sense I have. GPs often say somewhat rhetorically, although I do not disagree with them, that it is the most successful part of the health service. Perhaps other people in this room might have different views about that but they do make that point. I think they are right. It is a very successful and vital service carried out in a professional, efficient and effective manner for which I thank them. They deserve huge credit from this committee and society for the work they do and the efficiency and professionalism with which they deliver it.

In response to Deputy Kelleher, I must point out that the number of GPs in the system has increased. One of the first things this Government did was change the law to liberalise entry into general practice, which has been a success. There are concerns and issues which are legitimate and must be addressed. The issue of resourcing must be addressed across the board in terms of public services. We all understand that we want excellent public services and that they cost money, which brings us to the debate touched upon by the Minister in respect of how we fund our health services in the future, including primary care. We must all face up to this.

One clear question relates to who will be funding health services in the future. The answer is the people of Ireland. It is just a question of how they will be doing it. Regardless of whether it will be through taxation or an insurance-based system, the people of Ireland will be paying for it. Is it the case that it is more effective and equitable to do it through an insurance-based system? It is not just this Government that has said that. The resource allocation report commissioned by the former Minister for Health, Mary Harney, made the point that insurance-based systems have advantages because there is greater visibility in terms of what people pay and what they get from it. Other people say taxation is the way to do it. Can any Government persuade its electorate to pay the level of taxes that would be required to have a fully tax-based health system in the future? I do not know the answer to that question but I doubt it. We must have the debate. At the outset, Deputy Kelleher conceded that at least the universal health insurance white paper helps get this debate properly grounded in terms of-----