Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the Deputy for that. To the various points he has raised, we had a very good conversation about the State Claims Agency at this session last year, and colleagues pointed out that there was a very significant increase in that regard. We see it again this year, and the projections we have do not suggest that that increase will diminish unless we take action. There are actions we are taking. Two things are driving this: the number of claims has gone up and the amount being paid out has gone up. A lot of the payments are in obstetrics. There is a smaller number of claims there but the awards are very significant. The Deputy will be aware that there is a new incident review team - Dr. Peter McKenna is leading that - to look at any of these serious obstetric events to immediately learn from them and put in place measures to reduce to the greatest extent possible some of these really tragic outcomes in obstetrics. The Deputy will also be aware that I appointed Dr. Rhona Mahony to chair a piece of work to look at exactly this. We are coming at it, in the first instance, from a patient safety perspective. That is how we have to think about this. Yes, we need to reduce the amount of money. That is money we could be using to buy new medicines, hire more nurses or provide more services to patients. Medics have said to me - and the committee has probably heard testimony to this effect - that they feel that in some cases they are practising defensive medicine. That is not in the interests of their patients or our healthcare workers. No healthcare worker wants to be in a position where they are doing things for their patients only for fear of some lawyer finding a way to squeeze money out of them over it, so we are looking at that. I do not believe the current increase is acceptable. We have a high level of litigation in this country. It is high compared with international standards, particularly when one considers that the quality of our services is excellent compared with those in large parts of the world.

As regards medical cards, I fully agree with the Deputy on reducing the costs. As we all know, through the lifetime of this Government there has been a radical reduction in patient costs. We had a really important moment just a few weeks ago whereby now, for the first time ever, over half the population have access to free GP care. The latest half a million GP cards were targeted at the squeezed middle, those people who needed to see a doctor, needed to see their GP or needed to bring their child to a GP but could not afford the €55, €65 or €70 and the other associated costs. I hope that makes a difference. We have rolled out free contraception and free IVF. We have abolished inpatient hospital charges and significantly reduced the drug payment scheme maximums from, I think, €124 to €80. I agree with the Deputy's comments on an ongoing reduction in costs for patients. I think we have seen a lot of that. Some would argue that medical cards should be available for particular diseases - let us say cancer. While we all understand that at a human level, as regards the clinical advice on this, there was a review done on it some years ago that stated that we should not create a hierarchy of disease such that a cancer patient might get a medical card but someone with a neurological condition might not get one. The view was to base it on ability to pay. As we all know as TDs, discretionary medical cards are available.