Clare Daly (Dublin North, United Left) | Oireachtas source

There is something a little sick about a situation whereby we are in the House discussing a proposition to allow GP cards for children under six years against the backdrop of all of our offices being inundated with parents of children who happen to be slightly older than six years, perhaps teenagers, who are victims of the most appalling illnesses or disabilities. However, because of their age and because of the Government's changes to the discretionary medical card system, they are being denied the medical assistance they so desperately require.

When the issue was raised during Leaders' Questions yesterday, the Minister for Finance, Deputy Noonan, sort of laughed it off and asked whether the Deputies on this side of the House wanted everyone to have a medical card, as if this were some sort of outrageous proposition to put forward. In reality, the idea of universal health care for all citizens as a right based on medical need or necessity is something we should be fighting for, and it should be funded through a progressive taxation system, rather than a discretionary scheme which discriminates against people because of their financial means.

I wish to put on record my support for the parents who launched the Our Children's Health petition and campaign yesterday. They are demanding amendments to the Health Act 1970 such that all children, rather than only those under six years, particularly those who have been diagnosed with a serious illness or congenital condition, would be entitled not only to a GP visit card but to a full medical card based on medical need. This issue needed to be addressed urgently. In some ways the Government's proposition on this issue has been viewed as something of a stunt against the backdrop of the situation that many seriously ill children are in.

I offer one example of a child in my area who happens to be seven years of age. This child has had several operations since her birth. She was diagnosed with infantile scoliosis. The family have had a medical card since 2009, although both parents were working - they continue to do so - and they were around about the threshold. Last year the medical card was taken away from the family at a time when the child's health was deteriorating and when her consultant recommended that she needed a back brace and other medical assistance. The family applied for a medical card for the child but it was refused because of their income. Basically, as well as coping with the child's illness, they have spent the past year trying to deal with that. This has been completely and utterly demoralising for them. In an e-mail to me the father said - I find it heartbreaking - that if he gave up work the system would look after his family healthwise, but perhaps, by working, he was doing undue harm to his daughter in being unable to provide for her medical needs, a terrible thing for a parent to have to say.

We must address urgently the question of access to general practitioner, GP, care for all citizens, but other Deputies have highlighted that there have been considerable difficulties with the scheme from the beginning. There has been a kickback from the GP organisations. The Minister of State mentioned that the Government had sorted out the issue with them, but we will see. It has been ongoing for months, yet people will only start to debate it at the eleventh hour. How could the medical profession which one imagines is only concerned with looking after patients, building practices and doing a good job be driven into organising large public meetings and major e-mail campaigns and hounding politicians for months to be heard? There is something wrong somewhere along the line. I hope the heads of the agreement will sort out the problem, but many issues need to be addressed.

Like us all, the Minister of State will have received correspondence from a number of GPs, one of whom I will address. When this GP's assistant left the practice, the GP decided to emigrate because the stress of the job was too much. The practice could find no one to fill the vacancy, which is not uncommon. One of the factors that pushed the GP into deciding to emigrate was the idea of a GP contract for under six year olds. The doctor who had operated as a qualified GP for four years stated the Department's proposition had forced her into emigrating. She highlighted a number of issues with the original contract, which I hope will be sorted out in the Minister of State's talks. Under the scheme as proposed, she would have been asked to do work that had been scientifically discredited, for example, screening and measuring well children. She would have been asked to tick boxes and waste time on bureaucracy instead of dealing with sick patients. It gave no indication of how much GPs would be paid. How could any business operate like this? It created layers of extra supervision when GPs should only be engaged in looking after their patients. GPs were gagged in criticising the HSE. The GP concerned cited many other issues as an affront to GPs' professionalism. She concluded her correspondence by saying she was leaving the country to work in a system under which the state respected its full-time workers and that general practice, the one part of the health service that had been managing to function, albeit under strain, was being put into free fall by this measure.

The Government must fight an uphill battle in its talks with GPs who have overwhelmingly rejected the proposals made. If they are to give their agreement, I can only imagine that the current proposals stand the original scheme on its head. I hope these issues will be addressed, but bringing the scheme into being on top of the dysfunctional medical card system creates the wrong emphasis and is a poor way of doing business. This morning I received what could only be described as an hysterical telephone call from an upset wife, whose husband had been in hospital for the past month with Alzheimer's disease. She was facing the prospect of their medical card not being extended at the end of this month because allegedly they had not submitted enough information. When we rang to find out what financial information was being asked of this older citizen, it turned out to be copies of her house insurance and mortgage protection policies, her car log book showing travel expenses which she had never claimed in the first place and a GP's report which she had already submitted. The woman concerned who was dealing with a sick husband in hospital was told that, unless this information was submitted, her issues would not be addressed.

During the Private Members' time debate on medical cards I asked whether the system's dysfunction related to some extent to the fact that the reviews had been given to a German company, Arvato, to be conducted. It has been alleged that one reason there have been so many reviews since 2003 is that a private company's IT department performed a roll-over on a computer because of a backlog in 2012, which resulted in everyone, including people with no entitlement, receiving a medical card. Now the system is in free fall and trying to reclaim some of these medical cards. Innocent people who deserve their medical cards are being caught in the crossfire. When I raised in the House the issue of Arvato being involved in reviews, the HSE issued statements to the effect that that was not the case and that Arvato was only involved in data capture, whatever that phenomenon is supposed to be. That is not the case. I contend that Arvato is involved in the review of medical cards and either the Minister of State is not being told or he is not telling us.

The medical card centre in Finglas is staffed by a mixture of directly employed HSE workers and agency staff. The system is in complete mayhem. These agency staff who have been employed as a result of the public sector recruitment embargo and legislative changes which mean that they cannot be discriminated against in their pay are costing significantly more. Not only must they be paid the same amount as directly employed workers but the agency must also be given a cut of the profits. There are more than 100 workers in that category. The Arvato staff who have handled reviews received one day's training from existing staff, some of whom came from the HSE, while others had been seconded from the likes of the Central Statistics Office. I am sure they are good workers, but statistics and medical card reviews are entirely different. The people concerned did not receive training. When someone becomes a community welfare officer, he or she is given three to four week training, must sign the Official Secrets and Data Protection Acts and receive Garda clearance before ever being allowed to look at, for example, a rent allowance claim. No such checks are made in the much more sensitive matter of medical cards. Staff who have worked in the centre have put it to me that Garda clearance is not even sought until the person is made permanent, which might happen after four years.

The company lacks training in and an understanding of how the system works. This is the only explanation for the bizarre decisions being imposed on citizens. Let us be clear - these decisions mean the difference between people being able to manage in their lives and having the stuffing knocked out of them when they are at their most vulnerable, namely, when a loved one is sick, a child has a severe disability, etc. Unless the Government addresses these issues, it will be judged on the basis of callousness, over which no previous Government has stood. Lauding proposals to, for example, provide free GP care for all under six year olds as some sort of stunt is not sufficient. If the Government is serious about looking after the needs of children, it must move urgently for those whose ill health requires intervention now, regardless of their age. It should then get its act together and introduce universal health care.

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