Catherine Murphy (Kildare North, Independent) | Oireachtas source

I will take up where I left off last night. For me, the three critical issues in this legislation are the capacity of general practitioners to take on the additional work, whether what is proposed will be at the expense of sick children and other people losing their medical cards, and whether additional infrastructure will be put in place. For example, in some locations public health nurses are not able to carry out routine developmental checks and other vital health checks which detect problems at an early stage because of the reduction in their number and the pressures on the service. Two years ago, €20 million was made available in the budget for the recruitment of additional speech and language therapists in locations that had been identified as being most under-represented. Not all of those positions have been filled. My constituency happened to be one of the worst areas in that a quarter of all vacant positions were in that area. That should not come as a surprise, given the demographics of Tallaght, west Wicklow and Kildare. It is critically important these posts are filled if we are to be able to provide services for people who have been identified as having needs, particularly children. While a child's need for speech and language therapy may be detected at an early stage, because they often have to wait up to two years for services, they start school without their needs having been met, at great cost in later life to the child.

The Minister of State needs to explain who will bear the cost of this. The Daily Mailrecently published a five- or six-page article on a family who are constituents of mine and whose situation I have been raising for the past six or eight months. I also assisted them last year in putting together an appeal. If the Minister of State has not read it, I can forward a copy of it to him. This family, after succeeding in getting a medical card that was valid for three years, was told nine months later that it was up for review. The family, in which there are four children, is under incredible pressure. The youngest child will qualify for a medical card but the person in the household who needs it most, who is six years old and has cerebral palsy, will not. It is not only GP visits that are at issue in this situation; it is access to occupational and speech therapy, repairs to the child's wheelchair and so on. The child is also PEG-fed. That is just one example.

In some cases, the withdrawal of medical cards does not even make economic sense. I know of a man in his mid-thirties who is working and has two children and a mortgage. He needs a medical card because he has kidney failure. He told me that if he had to choose between paying for his medication to keep himself well or paying his mortgage he would choose to pay his mortgage. If this man does not get his medication he will end up on dialysis and will perhaps lose his job. While this will result in great cost, financially, to the State, the cost for that man will be greater. In another case, a mother had to give up her job in order to care for her baby who had to be fed through a tube. If the provision of this service is at the expense of such people, I would find it hard to support it. I want an assurance that this is not being provided at their expense.

General practitioners are of the view that patients who are well should not be used as ammunition to generate unnecessary health care activity when patients with higher needs are being routinely deprived of medical care. I believe it would be unethical of general practitioners to enable current Government policy, which is clearly aimed at political rather than health service gains. Although I understand that GPs are an interested group, it is important to listen to what they have to say. Some of what they are saying is very valid. I would not like to see a situation in which people have to make appointments and not see a GP for five or six days, thus putting pressure on acute hospital services. What would we be gaining? I have serious concerns about this legislation and look forward to hearing the Minister of State's response.

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