Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

It can be changed, as can the criteria of how we address discretion. Discretion is used by many other arms of the State every day of the week. We provide professionals with the powers to make decisions on a discretionary basis. We do not have legislation to decide how many home help hours someone gets because we trust the public health nurse and her valued judgment to award so many hours within the resources available.

That is discretion. It happens all the time and nobody questions it. We assess children for the provision of resource teaching hours by taking the word of a professional. That is their opinion. This is what we need to do in the case of discretionary medical cards. We need to allow people to make a professional, value judgment, unhindered by the policies pursued in the past two years in the context of a stated policy to reduce the number of discretionary medical cards. This policy of the Government to reduce the number of discretionary medical cards exists is written.

The Minister of State said he was meeting the IMO and others to discuss the contract in respect of children under six years of age. For a long time we have been talking about making primary care the focus in the delivery of health services in the years ahead. Unfortunately, we have spent a long time just talking about this and primary care teams, but we need to get to a position where we fund primary care services. The difficulty we have, as a result of policy, property bubbles and everything else that happened in recent years is that we have a fixation on massive primary care centres which have huge debts hanging over them. That is a concern. We have some fine primary care centres, but they have been holed below the water line financially. Many of them are in huge trouble. However, this should not stop us from trying to build critical mass in primary care services. Even with defined budgets, we must start to look at a way towards setting out a clear path. There must be a transfer of money from the acute hospital sector to primary care services over a period to build capacity. We talk about shifting the provision of chronic illness and disease treatment from the acute hospital to the primary care setting, but this must be resourced. General practitioners have pointed out that this will impact on their ability to treat patients and that is my concern. General practitioners are well able to advocate for themselves. They are professional and competent and have good organisations such as the National Association of General Practitioners and the IMO which act on their behalf.

The key point is that if we increase demand in the system because of the contract for children under six years, this will have consequences. One consequence will be that GPs will not be able to treat those people we want them to treat, including patients suffering from a chronic illness and disease, in the primary care setting. We have a defined number of people who are capable, competent and willing to do this work, but if they are obligated under a contract to provide services for children under six years, there is a serious concern that others will suffer. The people and general practitioners are concerned by this. My concern is that people with COPD, who have diabetes and suffer from other chronic illnesses will no longer be able to have a 45 minute or one hour consultation and that they will drift back to the acute hospital setting. This does not make sound economic sense because the acute hospital setting is the most expensive in delivering health care services. Primary care services must be funded, resourced and expanded.

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