Catherine Murphy (Kildare North, Independent)

There certainly are positives aspects to this Bill, such as opening up the General Medical Services scheme to a wider group of doctors. However, one concern I have is I honestly fail to discern a coherent approach to the issue of primary health care, and many others have made precisely the same point on areas that are not areas of advantage. There is no framework to provide some certainty and there is a lack of values that underpin this legislation. For example, a value I would expect to see is an entitlement to good quality primary health care. I am fairly sure I remember such an entitlement being included in the Charter of Fundamental Rights. However, it appears to have been sidelined in favour of the more central argument on economic matters, and social matters have taken a hit in consequence.

The proposals for universal health insurance contained in the programme for Government, or at least elements thereof, obviously will have an impact on the availability of or access to primary health care. I understand the need for a broad spread and the necessity to open up the availability of locations. However, it really commodifies health care and I have a major concern about this approach. It appears that when the troika sought changes, it only considered one dimension of what needs to be changed. Ireland has a highly fragmented health service, which largely has been inherited from our colonial past. Indeed, if one looks far back into the past, one will find the city of Dublin had a proud history of taking a pioneering approach to health care. For example, I believe the Rotunda Hospital was the first maternity hospital established in Europe. Similarly, the first operation performed under anaesthetic was carried out in the Richmond Hospital. It appears as though that fine pioneering approach has gone backwards in that the present system comprises a mixture of many things, and I cannot see coherence in the system under development. There are both not-for-profit and for-profit organisations as well as co-location, although I am unsure whether we got that far. In addition, there is a privatised service at primary level, albeit with some amalgamations such as the development of the doctors on call groups, which has been a worthwhile initiative. However, no coherence is evident and to open up the system in the absence of having values that should underpin the kind of health care to which we aspire is to miss a vital link. Consequently, some coherent overarching statements are required. I acknowledge some elements have been included in the programme for Government but how they are to be rolled out is not obvious. At what point will there be a health care system in which most people feel sufficiently confident to believe they do not require a form of secondary insurance arrangement if they can afford it?

I certainly do not oppose this measure but neither am I wildly enthusiastic about it. While it will do no harm, I have major doubts as to whether it will provide the kind of service that people, particularly in disadvantaged communities, should have an entitlement to expect as citizens of this country because I believe it will add to the existing fragmented approach. I would welcome a debate in this House on what will be the overall approach and what is the anticipated timeline for its arrival. Such a debate would discuss what it will look like, how a citizen who is ill will interact with it and when it will become a health system, as opposed to an illness system. The constant emergency that appears to face our hospital system will only be relieved if it is underpinned by a decent primary health care system in which people are kept well and only end up in acute hospitals if they become ill, rather than the present approach whereby one queues up repeatedly and is delayed even for elective surgery, after which it becomes an emergency.

That is the public perception of the health system. It is deeply damaging in terms of people's confidence and is certainly very frustrating for people working within that system, as we see regularly outside the gates here and also through people contacting us.

I have no doubt the Government would wish to put such a system in place but it would be very useful to understand what the nuts and bolts will be, rather than the "we have to do this because we are told to do it" type of approach. As I said, while I do not oppose the Bill, it is only a tiny part and is too fragmented.

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