Alex White (Dublin South, Labour) | Oireachtas source

One of the things we must do to make primary care work is to provide universal access to GP services. While I do not want to paraphrase or misrepresent anything Deputy Kelleher said in his earlier contribution, it is not entirely clear to me whether he agrees with a universal health care system. I am not trying to provoke an argument but to have the debate he said we should have. There will never be a perfect time for us to begin to implement a universal system. If we remove fees for people on low and middle incomes it will be good for them because they will not have to pay to go to the doctor, for all the reasons we know about. However, it has been shown that the barrier of fees prevents even relatively better off people from seeing their doctor. They have other priorities and do not attend. I have read lots of material that demonstrates this.
If one has a universal primary care system whereby people stay in the community and do not go to hospital, one must incentivise people to use it. The requirement to shell out €50 or €55 is a fundamental aspect of that. We want to eliminate the commercial barrier between people and their doctors or the primary care service and ensure they come into primary care and stay there as long as they can, unless they need to be referred to the acute services for a clinical reason. All the evidence shows that GP services without fees is the fundamental bedrock of developing primary care.
Deputy Kelleher and others often raise concerns about equity, comparing, for example, a child aged five whose parent is a Dáil Deputy and can well afford medical bills with other people. We could have a longer political debate, but equity issues regarding access to services should be determined by how people pay generally into the system, for example through taxation or insurance. We should have a pre-paid approach to health and we should all pay based on our ability to do so. Although everybody here should have to pay more into the system because we earn more, the system should be available equally to everybody, and the only criterion for somebody to use the health service should be whether they are ill and need it or not, including the preventative strategy.
Sometimes free GP care is presented as a sop or a political stunt. It is far from that. It is an essential prerequisite of a functioning primary care system. We are an outlier in the OECD and Europe in charging people €50 to €60 to see their doctor. It is a brake on developing primary care, and that is why we should provide free GP care. Let us deal with equity through the other policy instruments available to Governments, such as taxation or insurance.
The other aspect, as Deputy Kelleher will say, is that the services must be there, and he is correct. We are not resourcing primary care sufficiently and we need to resource it more. We need to adjust and move the resources as soon as we can into the primary care sector, which will be difficult. The Deputy's party was in government and saw how difficult it was, but it must be done. Free GP care is the sine qua nonof doing that.
Last year we introduced 250 to 260 new posts around the country, and that is critical. We need more posts, such as speech and language therapists, physiotherapists and all the ancillary support services. We need our primary care centres, and we are developing and opening them all the time, not just before the European and local elections but also after them. Recently, I opened primary care centres in Blanchardstown and County Meath. Last week, I opened one in Schull, County Cork.

These are fantastic and really superb services in the community. They are providing excellent GP and ancillary elements in the community, and in practical terms we are pulling such services into the community and away from the acute setting. That is what we must do. Of all the areas of public policy, this is one on which we should co-operate across parties. The Deputy's party introduced the strategy in 2001 and much of that document is still extremely valid, although it must be updated in some areas and some aspects may need significant work. There have also been new developments that will help us accelerate what we need to do in primary care. No matter what party or individuals are in Government in future, there will be no answer to the proposition that a developed primary care system is the only way we can address the increasing demands on health services, the aging population and chronic illness problems.

Contract engagement was the second issue raised. There is no way I would stand over any provision in a contract that would constitute a brake on people raising issues to do with patient safety or related matters. There has been an objection to one aspect of the draft contract, which we will discuss with the Irish Medical Organisation, IMO, and resolve properly. I could not stand over that. I hope the Deputy did not intend to suggest that people would be vindictive. Knowing the leadership in the HSE for patient safety and elsewhere as I do, I know it is absolutely a priority for the HSE to maintain and protect patient safety. I would not for a moment stand over any suggestion to the contrary. We all want to achieve that goal and there is no question of a conflict between wanting to have a contract in place on one hand and ensuring that people are free to voice concerns they may have about a service they directly witnessed or which occurs across a spectrum of work. We will address the issue of the so-called gagging clause in the discussions with the IMO and I am confident that we will reach agreement on it. I agree with the Deputy's sentiment.