Finian McGrath (Dublin North Central, Independent) | Oireachtas source

I am grateful for the opportunity to contribute to the debate. The Bill is relevant in the current climate, particularly in the context of the issue of discretionary medical cards and the horrific problems faced by sick and disabled children who are being hounded about their medical cards. Medical need must be the top priority, on which there can be no fudge. I call on the Government, in particular the Ministers for Health and Children and Youth Affairs, to act on this matter. It is a question of priorities and values. A society or state that does not look after the sick, the elderly or the disabled is going nowhere, but, above all, it is one without a heart. Let us deal, first, with the issue of sick children; second, look after the disabled; and, third, look after senior citizens. When we have dealt with these priorities, the Government can move on with its broader vision and reform plans and address the professionalism required in the health service. Anybody who says the opposite in this debate is not serious about providing a top class, quality health service, which is the objective of most Members. I agree with much of Deputy Denis Naughten's contribution. A consensus is emerging that we must provide a quality health service with universal access, which is professional, caring, humane and built on compassion. However, there is also the reality that it must be paid for.

The legislation provides for free GP care for children aged under six years who are ordinarily resident in the State. The HSE will provide a choice of GPs for this purpose in so far as it is practicable to do so. Nobody disagrees with that principle; therefore, I welcome the legislation. A total of 240,000 new children will have access to this service. Before that happens, the Minister must consider the position of the minority of children who are very ill. They must be prioritised. The Government also has to put into practice all the talk uttered by its members about the rights of children, the children's rights referendum and putting children first. We must ask ourselves whether we are doing this. We are not putting sick children first and enough is not being done for children with an intellectual or a physical disability or children who grow up in families in crisis or who come from disadvantaged backgrounds. These issues need to be addressed in this legislation which deals with the health and future of children.

I am annoyed when I consider the priorities that are sometimes accepted by the House. A classic example was yesterday's meeting of the Joint Committee on Justice, Defence and Equality, of which I am a member. We wanted a few clear answers on the issue of Garda whistleblowers and the Guerin report, but we could not get them. A number of inquiries are due to be held, some of which will cost approximately €2 million. This morning I was contacted by a group of parents from Darndale in my constituency who use an excellent preschool service that looks after 260 children and employs 100 staff. It is a beautiful example of a playschool that adopts best practice in dealing with vulnerable children and it works. I have been on site and met the children, parents and staff. However, they face a budgetary shortfall of €200,000. I raised the issue with the former Minister for Children and Youth Affairs, Deputy Frances Fitzgerald, and the newly appointed Minister, Deputy Charles Flanagan. There seems to be money available for many other projects, but sometimes when it comes to children's issues, they are parked and we have to kick and scream and jump up and down about them. Again, it is a question of priorities and values.

We need to support children with disabilities. Six months ago the Committee of Public Accounts investigated the disability sector in the context of the high wages being paid and the squandering of money. While that debate was ongoing, disability service providers were coming under pressure because of cutbacks of between 3% and 5%, but this was ignored. We need to face up to this issue.

In budget 2014, €37 million was allocated to cover the cost of accessing free GP care under this legislation, which equates to €154 per each child who gains eligibility. The legislation also amends the existing legislation on appeals concerning eligibility for GP services. The programme for Government, in the extract dealing with primary care, states:

Universal primary care will remove fees for GP care and will be introduced within this Government's term of office.

The legislative basis for Universal Primary Care will be establish under a Universal Primary Care Act.

Universal Primary Care will be introduced in phases so additional doctors, nurses and other primary care professionals can be recruited.

It is essential when introducing such changes that this be done in phases. The programme for Government also states:

Access to primary care without fees will be extended in the first year to claimants of free drugs under the Long-Term Illness Scheme at a cost of €17 million...

Access to care without fees will be extended to all in the final phase.

Many of us support this philosophy in providing a quality health service. I stress, at the same time, that we must pay for it, which will mean additional costs and, therefore, increases in taxation. However, most realistic, sensible people say privately that if they were guaranteed a good quality health service, they would not mind paying an extra few bob for it.

Fine Gael has looked to Holland and elsewhere for examples of best practice. However, the Government should examine universal health care systems that work in other countries such as Cuba. I have visited that country and its health service is amazing. The GP service is excellent when one considers Cuba is a poorer country than Ireland and being hammered by the United States through a trade embargo and sanctions. It is disgraceful that a small country such as Cuba is being hammered by the United States. They are located within kilometres of each other and people should sit down and resolve the issues involved, particularly when Cubans have a good quality primary health care system which we all could emulate. We have to be open and creative. Every society has its faults and extreme right-wing people will give out about Cuba, but that is their problem. The country has a quality health service that works and we should not be afraid to look at it.

The Government states it wants to plan a quality health service with universal access based on equality and medical need. Those of us who support that principle want to see this happen. However, on occasion the Government parties are not prepared to stand up for it. The cuts to child benefit were an attack on children. Meanwhile prescription charges for medical card holders increased to €2.50 per item, while the rate of stamp duty on pension schemes for senior citizens increased to 0.75%.

In addition, 35,000 medical cards were taken out of the system. Another disaster was the cut of the bereavement grant of €800. Maternity benefit was cut to €230 per week, which will cost mothers €832 this year. We must examine these issues as well if we are considering an overall health strategy and plan. It is important that we deal with these issues in the legislation.

We talk about costs and GPs' private fees. The data on GP private fees are not routinely collected, but sources say that an informal check found that the fees in urban areas were approximately €50 to €55 and that they were slightly lower in rural areas. In 2009 an Economic and Social Research Institute, ESRI, research paper by Samantha Smith stated that private charges for GP visits ranged from €40 and €60 and that the charges varied according to GP and could be hard to predict in advance. The Competition Authority has highlighted the rising cost of doctor visits and its impact, stating that the cost of visiting a GP had risen rapidly in recent years, significantly outpacing the general rate of inflation in the economy. It said there were indications that a substantial number of private patients were delaying GP visits due to cost factors and shopping around for cheaper consultation fees. That is something we must examine. We met such people on the doorsteps during the local election campaign, people who said they were afraid to pay the extra few bob to go to the GP. They were outside the threshold.

Health must be a priority. I missed the earlier part of the debate but I understand the issue with the GPs has been resolved. Is that correct?

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