Finian McGrath (Dublin North Central, Independent)

The last time I was in Cuba there was no smoking ban.

The EU-IMF programme provides for the introduction of legislative changes to remove restrictions to trade and competition in sheltered sectors by the end of the third quarter of 2011. This includes the elimination of restrictions on general practitioners wishing to obtain contracts to treat public patients under the GMS scheme. The contract between the individual GP and the Health Service Executive is based on an agreement concluded between the Minister for Health and the Irish Medical Organisation in 1989. It has been amended on a number of occasions since then and these amendments form part of the agreement.

Under this legislation, the HSE is required, before filling a vacant GMS panel or creating a new panel, to take account of the potential viability of the panel and the viability of existing GP practices in that area. The Bill will open access to GMS contracts to all fully qualified and vocationally trained GPs. There will be no limits on the number of contractors. This is a positive development because it will lead to opening up the services for the people. We must focus on the patient in this debate. We must also remind ourselves that we cannot have a mass exodus of GPs, in particular from disadvantaged areas.

I mentioned the Cuban health service. When I was in Havana I met a young medical student who told me that as part of his training, he was going to work in the villages and in the mountains for three months while the college was closed. This kind of work is very good training for young medical students. I would like to recognise the fantastic contribution Cuban doctors have made in countries like Haiti and in Africa over the past 30 years. They have made a massive contribution to improving health around the world.

In regard to GP services, let us remember that if we have good, effective and efficient GP services, it will reduce some of the problems in our accident and emergency departments. Let us face the reality that we have a crisis in our accident and emergency departments and we still have people on trolleys, which is unacceptable in 2011. Again, it boils down to the beds issue. We need a certain number of extra beds.

That leads us on to the broader debate of tax versus cuts. It is important that those of us who support a health service support a quality and equitable taxation system that pays for the health service. One cannot go around cutting services and expect people not to be on trolleys. Public opinion seems to be in favour of cuts. I think 25% of the population is interested in facing up to the reality that we need to pay for our health service. This must be done through general taxation.

In my constituency, Beaumont Hospital provides excellent services but, at times, it faces major crises in its accident and emergency department. We need to further develop cystic fibrosis services, in particular in Beaumont Hospital. I welcome the fact construction workers are on site at St. Vincent's hospital and I hope the unit there will be completed very quickly.

We need strategies to deal with the GP services but we also need national strategies to deal with the efficient way of running the services. I was absolutely amazed when I read that the fees paid to GPs for administering the 'flu vaccine were in the region of €42. I welcome yesterday's announcement by the Minister that he has reduced it to €28.50. It is important we cut fees to get value for money and to ensure people get a quality health service.

Another issue which should be dealt with is GP and medical services for people with intellectual disability. We must have more open-minded people and people who are specifically trained specifically to work in this area and act in a very professional manner.

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