Thomas Pringle (Donegal South West, Independent) | Oireachtas source

I welcome the opportunity to contribute to the debate. I give the Bill a guarded welcome, as the provision of universal health care rather than universal health insurance is something towards which the Government should strive. There has been a great deal of debate. Despite developments in the past year and a half in terms of the provision of medical cards, the bombshell only seemed to hit the Government when its members canvassed during the local elections and they realised that this was a serious issue for many across the country. We have seen some of the publicity generated in this regard. This shows the value of raising concerns in the House, even though they fell on deaf ears.

The problems with the medical card system, the removal of discretionary medical cards and the withdrawal of medical cards from seriously ill children and children with life-limiting disabilities have been raised in the House continuously in the past year and a half, yet the Government has not listened. It was only when its members started knocking on doors that they realised the extent of the anger over the issue. If the Government took note of what happens in this House it might not have received such a shock in recent weeks in realising the importance of these issues. When we see families with children aged under and over six years who are in dire need of their medical cards having them withdrawn and having to go through hoops to have them restored, it is an indication that the system does not care about them and that it is about saving money, as the Government laid out in the budget.

I have asked the Health Service Executive to consider that some people applying for medical cards for their children know that they exceed the income limit but they are applying for them on the basis of medical need. However, the Primary Care Reimbursement Service, PCRS, will go through the process of assessing their income, requesting additional information and delaying the decision on whether there is a medical need by forcing people to produce additional financial information when they know from the outset that they will not qualify and must get the application assessed on medical hardship grounds.

If the Minister intends to change the system and make it more responsive, I believe it could be done easily. When an application is received, rather than starting with assessment of means, it should be assessed on medical grounds initially to ensure that if somebody has a medical need they do not need to go through a means test and the card can be awarded. The problem with that system is that it is going on the premise that the PCRS wants to award the card. The problem is that applications are being dealt with in such a way that people are prevented from getting their entitlements. I believe that is being done because a certain number of people will not use the appeal or review systems and will not have the heart or the ability to battle the system to achieve that to which they are entitled.

In recent months the PCRS appears to have learned from the Department of Social Protection in terms of the way it deals with medical cards. When applications are submitted for medical cards now, the PCRS gives a commitment that they will be dealt with within 15 working days. They are not actually registered on the system for nine or ten days after they are received; the 15 working days does not start until they are registered on the system. I have dealt with many cases in which it was acknowledged to my office that an application had been received by the PCRS, but two weeks later it still had not been registered on the system as having been received. When we raise it with the PCRS we are told it has not received the application. When I state that we have an e-mail confirming receipt of the application, the response is that it has not been registered on the system. It is about delay and preventing people from getting fully through the system and receiving their medical cards.

Regarding the Bill, I welcome the Minister's indication that a framework agreement has been reached with the Irish Medical Organisation on the detail of the talks, but there are a number of issues in the proposed contract that must be highlighted. Other speakers highlighted the gagging clause whereby a general practitioner will not be able to say anything that brings the HSE into disrepute. That must be removed immediately, because it is madness. GPs must be able to talk about the way the health service is operating, bring information to the fore and ensure we can identify changes that must take place.

Also included in the framework agreement is the idea of health checks and regular health monitoring of the population, which I understand has been in the United Kingdom contracts for a number of years but which is being examined with a view to removing it from the contracts because it has not been shown that it is of any real value or that it works.

There is no doubt that the provision of free GP care to children under the age of six will lead to extra visits to GPs. The Growing Up in Ireland report estimates that there will be an increase of 0.6 visits per child if they receive free medical treatment and GP visits, but that has been overstated. I become concerned when I hear the IMO stating that medical card patients visit the doctor much more frequently than private patients. The reason for that is that people with medical cards generally are less well off or ill and therefore they need to visit the doctor more frequently. The number of extra visits may not be as high as has been indicated by some of the medical organisations, but there is no doubt that visits will increase.

I had three children under the age of five, and during those years we felt that we were visiting the doctor at every turn. There are many families waiting for that measure to be implemented so that they can rest assured that if their children need to visit the doctor they can afford to take them. As children reach the age of six or seven, the frequency with which they visit the doctor declines significantly because they are not as prone to chest, throat or ear infections.

Another concern about the legislation is that access to medical cards may be restricted for children under the age of six. The Minister denied this in his contribution, but the evidence within the medical card system makes a lie of that. I hope it does not happen, but I believe the medical card system will use the fact that children under six have free GP visits to restrict access to medical cards for those children. That is being rolled out, but I believe we will be here in a year's time raising incidents of children who are covered by the legislation being unable to access medical cards. That they get free GP visits will be used against them and their families to restrict their access to medical cards. I hope that will not happen but I believe it will happen because all the evidence shows that the way medical cards are being dealt with currently will be used to restrict access by children who are ill to the additional supports and care they need.

There has been talk - the Minister mentioned it and it will probably be dealt with in the talks under the framework agreement - of some limitation on the number of visits a child under six will be entitled to under this system. I hope that does not rear its head again, because it will make a mockery of the entire system. Probity reviews were brought in this year. Will similar probity reviews be carried out under forthcoming budgets to limit the number of visits children under six can make to their GP under this scheme?

Another aspect of the legislation that concerns me is the idea that to qualify under the scheme one must be ordinarily resident in the State for at least one year. I have a lot of experience of dealing with habitual residence conditions within the area of social protection. It is a system that is used to restrict access and make sure that people who have a genuine need for payments cannot get them. People are being refused without any regard to the conditions for qualification. What people need to be able to show that they qualify under this residency condition is laid out, but the Department of Social Protection ignores them and refuses people in the hope that a number of them will not continue to fight through the system.

See this speech in context