Liam Twomey (Wexford, Fine Gael) | Oireachtas source

Many resources are aimed at people aged over 70 years, but no one has suggested giving a medical card to every child under the age of five years. What about the young parents who are unsure about whether their children are sick because the latter cannot express what is wrong with them? No one believes that there is a need to discuss such people. Sinn Féin has its usual approach - give everyone whatever he or she wants.

If anything has come through in this discussion, it is the fact that a blatant political stroke was pulled when a medical card was given to everyone aged over 70 years without there being any policy to support the move or any view of what the ideas of eligibility and universality constituted in a health care, educational or other setting. We are now hearing the usual commentary that we heard during the past decade, for example, whether that measure was right. It does not matter.

No one has mentioned the suggestion of a patient safety authority. Most democracies have such authorities. We are in the process of developing one. I raised the issue a number of years ago. The former Minister, Ms Mary Harney, established a commission to get the idea off the agenda. The current Minister, Deputy Reilly, is considering the idea seriously. Such an organisation would look after patients.

Much of what has been mentioned about the Minister being able to change eligibility and universality under this legislation is not technically true. It is a question of how these parts of the legislation work. After a bad week, the Minister will not change everything on a whim or because someone annoyed him. We need a better approach, for example, a patient safety authority. Such an approach would work. For example, the Mental Health Commission has revolutionised how the health service perceives patients with mental health issues. It has removed the paternalistic view that the doctor always knows what is best for people with mental health issues. Those people know their illnesses well, but they are also vulnerable. The commission has made a difference.

If we are to be progressive in how we manage health, we should establish a patient safety authority that would consider questions of eligibility for accessing services. The medical card is not just about GP care. It also determines whether a person gets to see a public health nurse. One's entitlement to a range of services is automatic when one has a medical card. If one does not have a medical card, one is not entitled. For example, if a retired schoolteacher happens to have some savings and presents to me for bad leg ulcers, getting a public health nurse to see him or her is difficult, as he or she is not entitled to that service. We should discuss issues such as this and determine how to move them forward.

Maternity care is a free service for every woman. One is entitled to free GP and hospital care while one is pregnant and for up to six weeks after one's child is born. If we are really discussing how to move the concept of eligibility onwards, let us consider extending this service in the next budget so that the child is protected for up to one year after birth. In the following budget, change that to two years. In the subsequent budget, change it to three years.

Let us start considering what "universality" means. We can put income limits on that provision if, for example, the view is taken that Deputies with young families are too prosperous to have it extended to them, but we should consider how to provide services for everyone else in society.

All of the commentary in this debate has been reactive on the issues of the elderly, people with long-term illnesses and the Minister's remarks a number of years ago. Nothing new has been added to our considerations. The parties' representatives should meet the many societies that are considering this issue and are suggesting that legislation should be put in place to underpin service delivery for patients, albeit not necessarily free GP care for everyone. We should consider what we can do for our citizens at all times.

I hope that the economic crash of recent years will be a blip in our history. It will not crash like that again, 250,000 people will not become unemployed in the course of a few years and 600,000 husbands, wives and children will not need medical cards because a Government made a royal mess. If we debate matters now, put certain principles in place and underpin universality, we could build year on year. I had hoped that ideas such as this would be discussed during this debate.

We know what will occur in terms of primary care. I am not privy to what the Minister or the Minister of State, Deputy White, think on this issue, but I have a fair idea about how primary care works. GPs will be paid less to look after more patients. There is an expectation that practice nurses and other health care professionals will do more primary care work and that GPs will have an overarching role in patient care. There will be greater co-operation and, I hope, value.

Primary care teams and primary care buildings are not the only solution to making primary care work. They are an expensive solution and other options are available. The 300 additional health care professionals who have been promised are vital, particularly because deficiencies have been identified in certain areas. The HSE failed to provide universal health care. Universality does not mean that everyone should have everything. Rather, it means that we should all have the same chance in light of the level of resources that are available. County Wexford should have the same number of speech and language therapists as County Galway. We should have the same level of occupation therapists as County Waterford. That there are seven times more occupational therapists in County Waterford than there are in County Wexford is amazing, given the fact that it is just across the river from us. The HSE failed to do what it was supposed to do.

That was a strong criticism of it. Even though I was very critical of the HSE I am aware it developed its corporate memory and corporate structures to the extent that it was managing to work better than was previously the case.

The Minister of State, Deputy Alex White, is very much in favour of the collation of information. A significant amount of information is generated in primary care. With few changes the Department of Health could access the information. At this stage 90% of general practitioners are computerised. All payments should be made on the Internet. Disease coding should be introduced and applied to every single patient. A chronic disease management programme should be introduced for patients. That would require a new contract with GPs but that is not impossible and has been done previously. There is no reason why it could not be done again. We would get a tremendous amount of information were such a system to be introduced. We could identify pockets of the country where health needs are greatest. We would know about the prevalence of heart disease, diabetes and obesity instead of assuming we know, having the HSE second-guessing or spending large amounts of money to find out such information. The information would be readily available from the 22 million consultations carried out by GPs every year. We are not collating the information in the way we should.

The Minister of State, Deputy White, visited the Caredoc service in County Carlow to see how such a system works there and how the health service could be run like any other business. The service does not need to be erratic or all over the place. One can identify trends in health care but we are not collecting the information. That would add hugely to how we make decisions on eligibility and make medical cards and other services part of universal health care. That is the type of thinking and discussion we should have in the Chamber. That discussion is happening outside of the House. Instead we get nonsense about who said what, who did this and that and who did not do this or that. That is a pity. The argument about private health insurance and what went wrong with it in terms of community rating dates back to 2006 and a court case BUPA took to Europe about the initial legislation that was introduced. We must acknowledge that the issue is tricky and difficult to work out.

Prescription charges were raised and comments were made about the Government being uncaring. I read a report concerning a call by the Irish Pharmaceutical Union for its members to collect drugs its patients had not used that were out of date and lying around in cupboards in people’s homes that should not be there. The campaign was run for three months and three tonnes of unused medication were collected. It would save a significant amount of money if we had a better system of monitoring drug use, patient compliance with taking medication and prescriptions were not given out willy-nilly that are not necessary and are going off in cupboards at home. Rather than having a bog standard political debate about the Government increasing charges and Members quoting back what Government party members said four years ago, let us examine whether there is another way to improve compliance by talking to patients about how to make the system work. That would reduce our drugs bill and thereby reduce the approximately €300 million worth of cuts we must make in the primary care system this year. It would also reduce the €2 billion we spend on primary care. A remark was made by a Member of the Opposition that the €2 billion spent on primary care was just fettled away. A good service is provided. However, it is true that a significant amount of waste is still ongoing in the way medication is used in primary care and the hospital system. A remarkable amount of waste is evident in how we deliver health services to patients. When I began in general practice I had no practice nurse and one secretary. A significant amount of the work I did then is now done by the practice nurse. That change has taken place in a considerable number of general practices so even though there has not been a significant increase in the number of GPs in recent years there is still an increased amount of throughput in general practices because of the improved system of organisation.

If hospitals were to organise themselves as well as the primary care sector significant savings could be made there also. That is not to say there is not scope for further efficiencies and a better use of the expertise of doctors and nurses in primary care, which is still to come. The debate in which we should engage in the House is how we can make the primary care system work better. If we make the necessary changes to primary care it will reduce the amount of cuts that are required elsewhere. We must be efficient in what we do. Some efficiencies are driven by the hospital sector and others are caused by it. Some of the efficiencies were based on a protocol on how patients should be X-rayed so as not to waste X-ray resources. Equally, we could introduce protocols on how we take routine blood samples from patients so that we do not just take a blood cholesterol test because a patient has not turned up for six months or that we carry out a full blood count, FBC, test because a patient looks a bit pale from a hard weekend in Galway. There is a need to examine how we can make the health service work. If we do that it will improve our opportunity to provide more services for patients and possibly at no cost. That is how a free GP care service will be delivered over a number of years.

I accept legislative issues require to be dealt with, but the issues that exist in primary care have not been examined either by this House or any political party. I hear much about the need for free GP care and suggestions by the Opposition on what we should do but nobody has set out a structure for how that is to be achieved. Nobody has provided an action plan. Both the Minister, Deputy Reilly, and especially the Minister of State, Deputy Alex White, share a desire to understand how the system works and to roll out an action plan to make it work. That must be the focus of the debate in this House. In so doing, patients will say we are relevant to what happens in their lives. I urge Members to steer clear of what has passed for debate in the past hour and a half.

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