Alex White (Dublin South, Labour) | Oireachtas source

Obviously, I am in the hands of the Chair as to whether an amendment is or is not in order. It is not a matter for me but for the Chairman. However, I have considerable sympathy, certainly in principle, for the issue raised by Deputy Ó Caoláin and commented on by Deputy Naughten. I have met a number of groups, including representatives of the Our Children's Health campaign with whom I had a very good meeting two weeks ago, at which we discussed and debated this issue. The Government has decided to develop a new policy framework of eligibility for health services to take account of medical conditions but this pertains to eligibility for health services in the broadest sense and is not confined to free general practitioner, GP, care. The expert panel and the process to which the Government intends to give consideration will relate to the broad scope of services and will not be confined to GP services. However, the Bill being debated today pertains to the extension of GP services to the entire community by 2016 in the context of the commitment in the programme for Government. Whereas the two things are not unconnected - I will not suggest to Deputy Naughten they are completely unconnected - they are two separate strands on which members must be clear.

When I told the sub-committee earlier that it became clear that going by way of chronic illnesses would be cumbersome, the point I was making was that if members all are serious about moving as quickly as possible to universal access to GP services, the quickest and more expeditious way of doing that would be to at least start by this interim approach by way of age cohort. To take it at its simplest, none of this is particularly simple or simplistic, but if the criteria are that one is below a certain age and that one lives in the country, these are pretty straightforward conditions in order for somebody to qualify. However, if the conditionality is more complex with regard to a condition, an illness and so on, merely on the face of it, that quite clearly is more difficult. There is no doubt that while it is not impossible, it is more difficult. It was on that basis that I asked what was the quickest route to achieving free GP care for the entire population and in my judgment, with which the Government agreed, it would be better to proceed in the way that I propose.

However, the expert panel that has been established with regard to eligibility for broader health services will report in September. It is an expert clinical panel to examine the range of conditions that should be considered as part of the process. I do not wish to prejudge the work of the expert group. The Government has already stated it will develop legislation as necessary resulting from that expert panel's deliberations and that will take place. It would be inappropriate and I could not agree to seek to amend this legislation, either now or on Report Stage, because so doing would prejudge the work of the expert panel, which would be inappropriate. However, I make the point to colleagues that there is more than an understanding of the issue the Deputy raises in the amendment that has been ruled out of order. I can understand and am full of sympathy for the issue the Deputy raises and it will be addressed in the context I have mentioned. Meanwhile, what is being developed here is the implementation of a GP service without fees for the entire population. This is a stepping-stone, as I described it earlier. This is what it is intended to be and I again emphasise that were it simply just a once-off or a stand-alone measure, it would not have the merit I believe it has as a first phase of a population-wide scheme. I make this point in good faith through the Chairman to the Deputies. Deputy Ó Caoláin and the other members have raised this issue before and I say in good faith that I ask them to take my bona fides and that of the Government because this is the intention. The programme for Government commitment is to implement GP services without fees for the entire population. As for the future phasing, what will happen next and what are the main components therein, the first step is the legislation I will respectfully be asking the Houses to pass. The second is an engagement with the Irish Medical Organisation, IMO, which now is possible because in recent weeks, I have agreed a framework with the IMO to facilitate a real engagement and negotiation on these matters, which was not in place heretofore. It was either in 2006 or 2008 when the Competition Authority intervened in this whole area and since then, there essentially has been a stand-off between the State and the representatives of the GPs regarding a basis for negotiation, discussion and so on. That problem now has been cracked. While we do not have an agreement on the actual content of the work the Government hopes people will undertake, at least there is now a basis for people to have discussions and hopefully to agree. This is a further thing that has been achieved in recent weeks.

The final aspect about which Deputies Healy, Ó Caoláin and others asked is where does one go after the under-sixes. This is a perfectly legitimate question that I would love to be able to answer fully today. I cannot but what I will say - the Government repeated this again this week - is that by September, a comprehensive paper is to be submitted to the Government outlining the future steps and phases of the roll-out of free GP care. The Government and I are absolutely determined that the aforementioned paper will be prepared, completed and agreed at or about the same time as the other work that is being conducted with regard to the separate but connected area of the expert panel. This has been incremental and has been slower than I would have liked. Many things in the current Government have happened more slowly than many of us on the Government side would have liked but progress has been made in this regard. It is in that context that I seek the support of colleagues for this legislation. It is a stepping stone that will be followed by a paper in September with regard to the future roll-out. It also will be followed, I hope, by meaningful engagement and negotiations with the IMO to actually implement the scheme.