Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I will make a general reply to the Minister of State's remarks before dealing with the detail of the Bill. I was one of the people who expressed a qualified and nuanced support for the legislation when it was discussed on Second Stage, in view of what has happened with regard to medical cards over the past two years. While the Minister of State says that GP care for children under the age of six is a stepping stone towards universal primary health care the Minister of State should note that a person using a stepping stone should not put two big feet into the water. I am afraid that is what the Government did when it decided to go down the road of the removal of discretionary medical cards. I make that comment in the knowledge that I must outline my position.

Universal health care should not be discussed as a Utopian abstract concept. Universal GP services will cost money and it means that the money must be found from somewhere or else funding must be reduced in another health area. People who are obese have had their gastric band surgery cancelled. This is a death sentence for them. While services and funding of services are listed by priority, we must be conscious that certain priorities need to be addressed before we can broaden the areas of universal health care. The issue of discretionary medical cards is a case in point but in my view it is a very principled issue. We cannot tolerate a situation where very old and very sick people are no longer prioritised in our health system. What is left after looking after them should be disbursed to others. Resources will always be finite and it will not be possible to fund every strand of the health services and therefore certain areas must be prioritised in a structured manner.

The Bill provides for ring-fencing €37 million but that money is taken from somewhere. There is no point in pretending that this money can be plucked out of the air or from anywhere other than the national accounts. It is ring-fenced away from those who currently need it most because the resources are not sufficient to fund the discretionary medical card system. This was evident in last year's Estimates. As Fianna Fáil said at the time, the probity exercise was a code for the pillaging and culling of discretionary medical cards. This has been shown up by the Government's U-turn which I welcome. It is unfortunate that the U-turn did not happen some time ago when the issue was highlighted by everyone in the House. The Minister, Deputy Reilly, refers to the unintended consequences of the discretionary medical card issue. The only unintended consequence was that the Government lost a lot of council seats.

That was the real unintended consequence, and as a result of it a U-turn was performed. I am quite certain, however, that if Fine Gael and the Labour Party had enjoyed a good day at the local election polls, the so-called unintended consequences would have been allowed to continue and there would have been no U-turn on the withdrawal of discretionary medical cards.

We must have a genuine and comprehensive debate on the funding of our health service, including primary care and GP services, and prioritising access to ensure that those who need the services most and cannot afford them receive at least some assistance from the State over and above that afforded to persons who can afford them and do not need them as much. The whole regime of discretionary medical cards should be expanded in such a way as to incorporate some element of humanity and compassion into our health system. Where a person or family is visited by an extraordinary difficulty, even where the household in question can generally afford private health insurance and GP visits, the State must step in to offer support in a meaningful way. That is what social solidarity should be about, as opposed to trying to be all things to all people. The easiest thing for me to do, as an Opposition spokesperson, would be to say that the provision of free medical cards to the under sixes is a great idea but it should be extended to the under tens. That is what a populist Opposition would do. We realise that when there are finite resources, one must prioritise. However, the fact that we are still counting the number of incontinence pads being given out in nursing homes while in the same breath talking about giving GP cards to people who may be on a huge income is a little difficult to understand.

A broader debate is required in the context of this Bill. These proposals feed into the area of universal health insurance and are part of the Government's package to reform how we fund the health services and access to those services. The difficulty I have is that the words we are hearing are very different from the actions we are seeing. The Government must accept, just as it should have accepted there was a problem with discretionary medical cards, that there are inherent problems in primary care and with GP services. The ostrich syndrome can no longer continue in the Department of Health and at ministerial level. There is an inherent problem in the fact that GPs - highly qualified, professional people - are finding they can no longer contemplate working in this country and are choosing to go abroad. The solution is not just about offering attractive remunerative packages; there is an array of problems in the system. I urge the Minister of State not to deny this is an issue when the evidence is so clear. We do not want to wake up one day and discover that all our GPs have gone to Canada or Australia while we are left scouring the Third World to find replacements to fill the vacuum. That is not in any way being responsible either to our own people or to the people in other countries who also need GP services. Why are we taking their best doctors while sending our own to other parts of the First World? The Minister of State must accept that this Bill is building on a very perilous foundation, because primary care and GP services are in trouble.