Alex White (Dublin South, Labour) | Oireachtas source

I thank Deputies for their contributions to the debates on the various Stages of this critically important legislation which incorporates a public health initiative, of which we can be proud. Despite the great financial constraints and retrenchment that have marked recent years, most notably in the health service, the legislation highlights the fact that we are taking a first step together to reform the health system and put in place, beginning with those under six years of age, universal access to GP services. I thank Deputies for taking in good faith my assertion that the legislation is, in accordance with commitments in the programme for Government, only the first step in the introduction of this necessary service.

Deputy Caoimhghín Ó Caoláin has stated what we are doing is taking place against an unhappy backdrop and I am inclined to agree with him in that regard. We have, to some extent, been struggling to address the issue of medical cards awarded on a discretionary basis and decisions made in that regard. I agree with the Deputy that this is not the context in which we would want to be discussing and deliberating on a universal system of health care. The first priority of the health service must be to deal with those who are ill and need immediate access to care and services. It must be stated that in trying to deal with the various anomalies, contradictions and injustices that arise and the real need among families with sick children and adults with particular medical conditions, we must also begin to consider how best we might introduce a universal system of health care. For many people, including me, the introduction of such a system is ultimately the only way to address the issues to which I refer. We are trying to operate on two fronts and I accept the Deputy's assertion to the effect that this is not the ideal backdrop to what we are seeking to do. However, that fact is not a basis for stating we will delay the introduction of a universal system of health care. Notwithstanding the contradictions, anomalies and injustices that have been thrown up in the context of the existing medical card system, I remain convinced that we are right to proceed with introducing the universal system.

In the context of appeals, those who have not heard from the PCRS by mid-July should contact the HSE about the return of their discretionary medical cards. The PCRS is working through the cases it has in hand in respect of individuals and families and I am advised that it is making good progress. It is anxious to expedite matters, but if people have not heard from it by the middle of July, they should seek to make contact.

What Deputy Denis Naughten said is true in many ways. He referred to institutionalising discrimination, but, as he acknowledged, there was already that discrimination. In that context and if I recall the figures correctly, the rate for the awarding of discretionary medical cards in Cork was 71% above the national average, while in County Meath it was in the order of 68% below the average. The position differed in all other counties in between. That simply cannot be right, fair or just. Some people have stated the rates differed so significantly as a result of, for example, the strength of the advocacy in various areas. I do not know whether that is the reason. No one is ever going to criticise a local health officer for helping a family. Why, in all humanity, would anyone do so? At the same time, however, we, as legislators, and the Government must ensure fairness and see to it that resources are allocated properly. I hope I am not interpreting her words incorrectly, but Deputy Róiin Shortall stated resources should be allocated in a fair and just way, not to the person who shouts loudest. I agree with her in that regard and, ultimately, that is what we are seeking to do.

Deputy Denis Naughten was right when he referred to the problem vis-à-vispeople whose medical cards had been withdrawn and then returned and those who never had them in the first instance. That problem has been ongoing for some time, but it will ultimately be solved.

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