Alex White (Dublin South, Labour) | Oireachtas source

I thank the Deputies for their contributions on this Second Stage debate. The contributions were extremely thoughtful, not just on what is provided for in the Bill but also on the broader issue of medical cards, the awarding of medical cards and the allocation of resources generally. It has been a very good debate.

The Government is committed to introducing, on a phased basis, a universal GP service without fees for the entire population within its term of office, as set out in the programme for Government and in the Future Health strategy framework. It has been decided to commence the roll-out of a universal GP service by providing all children under the age of six years with access to a GP service without fees. I emphasise, as Deputy McGrath and others fairly acknowledged, that this is just the first phase of a comprehensive project. Additional earmarked funding of €37 million was provided in budget 2014 to fund this first phase.

It has been made very clear that this measure is not being funded on foot of savings implemented elsewhere in the health system. There are good reasons to provide universal access to GP care in view of the health needs of this particular age cohort. The early identification of health issues at a young age can mitigate or reduce the impact of ill health later in life. I am aware that Deputies have raised concerns regarding medical cards awarded on foot of the exercise of its discretion by the HSE. I will return to that issue before I conclude.

The legislation's key features are the entitlement for all children aged five years and younger to a GP service without fees, the removal of the need for children age five and under to have a medical card or GP visit card under the GMS scheme to qualify for the GP service, and a provision whereby the HSE may enter a contract with GPs for the provision of the GP service to children. The Bill further provides that the Minister may set the rate of fees payable to GPs for the service.

As I stated on Second Stage yesterday, I was pleased to announce the conclusion of a framework agreement with the Irish Medical Organisation. The framework agreement sets out a process for engagement on the whole GMS GP contract and other publicly funded contracts involving GPs. The agreement has been reached following a series of discussions with the IMO by the HSE and the Department, led by myself. The framework agreement sets out an agreed process for engagement on all aspects of the GMS contract with GPs with due regard to the IMO's role as a representative body for medical practitioners and within the context of the provisions of the primary legislation to underpin the introduction of GP care free at the point of access. I look forward to a meaningful engagement with the IMO on the GP contract.

I welcome the support expressed by Deputies in the House for the further strengthening of primary care services generally in Ireland. I acknowledge that endorsement has also been given by most if not all speakers to the introduction of universal access to the health system in place of the existing two-tier health system as soon as possible. Contrary to the concerns raised, for example, by Deputy Billy Kelleher, it is not expected that the Bill will have a dramatic impact on the capacity of the GP service in Ireland. We have done some modelling work on the impact which shows there will be some. It is an issue I look forward to discussing with the representatives of GPs in the course of our engagement on the new contract we now need.

There has been a suggestion that the approach of discretion worked well in the past. While I acknowledge this, it is a fact that significant regional variations in the issuing of discretionary cards arose. For example, 24 cards per 1,000 persons were issued in Cork while four cards per 1,000 persons were issued in Meath. In the view of the ombudsman, the different treatment of persons depending on geographical location is improperly discriminatory, an undesirable administrative practice and contrary to fair or sound administration. I reject the suggestion that the number of discretionary medical cards was increased by 800 cards in April for what a Deputy described as "election purposes". The HSE has never ceased awarding medical cards through the exercise of discretion in accordance with the framework set out in the health legislation.

Notwithstanding the foregoing, the Government is very aware of public concern about medical cards. The Cabinet sub-committee on health met this morning and decided to develop the policy framework governing eligibility in a manner which also takes account of medical conditions. The HSE will establish an expert panel to examine the range of conditions that should be brought into consideration. The process will include the development of a new legislative framework as necessary. In light of the decision, the HSE's Director General will now suspend reviews of medical cards where discretion has been exercised to take account of medical circumstances. The Department of Health has also been mandated to develop a policy paper on the further roll-out of GP care free at the point of access in the context of the move to universal health insurance. The Minister for Health will present a memorandum for Government setting out the next steps in this regard.

To return to the Bill, as all children aged five years and under will be covered by the new GP service under the Bill, children who have not yet attained the age of six will be removed from the existing GP service under the medical card scheme. It is important to be crystal clear that children aged under six who are currently entitled to a medical card will continue to qualify for a medical card and their entitlement to other health services, including prescription drugs, will not be affected. The Bill provides a framework whereby the HSE will be entitled to enter into a contract with any suitably qualified and vocationally trained GP for the provisions of general practitioner services to all children aged five years and younger. The Minister for Health may, by regulation, with the consent of the Minister for Public Expenditure and Reform, fix the rate of fees and allowances to be paid to GPs for services provided under these contracts. The relevant section requires that the Minister in making a regulation for this purpose must engage in consultations and it prescribes the role of the Minister and HSE, the nature and manner of the consultations and the considerations to which the Minster must have regard in making regulations.

The new framework agreement we have reached with the IMO will govern the basis of our engagement, consultation and negotiations with the representatives of GPs so that they are integrally involved in the planning, roll-out and necessary contractual arrangements needed to underpin this new service. I look forward to that real and meaningful engagement, as sought by the IMO, on all aspects of the contract.

I thank Deputies for their contributions on the proposed legislation and commend the Bill to the House.

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