Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I move: "That the Bill be now read a Second Time."

It is my pleasure to introduce Second Stage of the Health (General Practitioner Service) Bill 2015 to the Dáil. The Bill will provide for a universal GP service to be made available to all persons aged 70 and older. This is the second phase of the introduction of a universal GP service in Ireland which builds on the first phase which covered children aged under six years. Together with the under-six phase, by the summer the second phase will result in more than 300,000 children and senior citizens who currently must pay to see their GP no longer having to decide whether they should spend €50 to visit their GP. This phased extension of universal coverage will come as a relief to many young families and pensioners.

Under the new legislation, access to a GP service will be provided to all persons over the age of 70 on a universal basis. This will replace the existing GP service arrangement for over-70s, where their income must be assessed before they can access a GP without a charge. Their dependants, including spouses or partners, who are under the age of 70 will continue to have access to a GP service without fees where they meet the existing income limits.

The Government remains committed to the introduction of a universal GP service for the entire population in line with the programme for Government. As set out in its Statement of Government Priorities 2014 -2016, the Government prioritised the over-70s in the next phase of the roll-out of free access to GP care. The Government is now living up to that commitment. General practice or family practice is often viewed as the core of primary care. The GP plays a crucial role as a gateway to the entire health system. The generalist and patient-centred GP approach guides the patient through the referral process and health care system. It is widely considered that a well developed system of primary care has beneficial effects on the health care system as a whole. As previously announced, the Government decided to commence the roll-out of a universal GP service for the entire population by, first, providing all children under six years and, second, persons over 70 years of age with access to a universal GP service. The decision to prioritise the over-70s cohort next for the roll-out of a universal GP service had regard to the significant prevalence and co-morbidity of chronic diseases in the over-70s population. Therefore, there is a significant benefit to be achieved from improved GP access in terms of health and well-being. There are approximately 400,000 people over the age of 70 in Ireland. It is estimated that approximately 36,000 people over the age of 70 must currently pay to attend a GP because they are not covered by a medical card or a GP visit card. Medical evidence suggests that there is a significantly greater incidence of multiple chronic conditions among persons over the age of 70. That emphasises the benefit of access to GP care without fees for persons in this age category.

It is important to be clear that nothing will change for any person over 70 years of age who has or is eligible for a medical card. Such persons will continue to receive all of their other medical card entitlements as normal. Deputies will be aware that our current arrangement of health care provision can be traced back to the mid-19th century where limited services were provided to those who were unable to pay for them. That, I believe, is an inappropriate basis for a 21st century health system. It is far from any comparable modern health system of any other European country. It emphasises the importance of moving towards a health system based on universality of access. The concept of eligibility has been somewhat amended by legislation, most recently in 1991 and 2005. However, the fundamental principle of means-testing access to health services was retained by the Oireachtas on both occasions. One result has been that the means-based legislative framework has produced a very complicated eligibility system, which must take account of a person's "overall financial situation" as stated in the Health Act 1970. This system is very likely to confuse people, and almost certainly makes it impossible for a person to know whether he or she qualifies for a medical card.

It is clear from the real concerns raised by members of the public that there are difficulties for some persons with permanent conditions in gaining access to health services under the medical card scheme. This is a problem we must address. It is being treated as a priority by the Government which has been examining the issues involved and is working towards a solution.

On top of this complexity, we have added a supplementary eligibility assessment process for persons aged over 70 years of age. We must move towards a health system based on universality of access and which must be sustainably funded to enable the provision of services to meet health needs. I recognise that a move from a means-based eligibility system to a universal system of health coverage is challenging. We are in the process of reorientating the health system from one that only treats sick people to one that keeps people well. That is why a universal system is the best option. There is a good case to say the existing eligibility system has become overly complex, which has resulted in people focusing on the assessment process rather than the provision of services. We should not lose sight of the fact that the key issue is that an ill person should be able to receive primary health services. At the same time, we must stay committed to completing the most radical reform of the system in the history of the State to develop a universal system that treats all according to their health needs, not their means.

While we are making progress on universal access to GP care, the Government also recognises that the health service needs to be responsive to the circumstances of people with significant medical needs. Late last year the Minister for Health and I announced a series of measures to enhance the operation of the medical card scheme to make it more sensitive to people's needs, especially where serious illness was involved. The medical card system is now operating in a more sensible and sensitive manner. Clearly, greater discretion is being exercised by the HSE. The number of discretionary medical cards in circulation has increased by approximately 56%, from approximately 52,000 in mid-2014 to over 81,000 at the start of March this year.

I will briefly outline the main provisions of the Bill. Section 2 amends section 58 of the Health Act 1970 to remove all individuals over 70 years from the scope of the means-tested service based on holding a medical card or a GP visit card. Instead, all persons over 70 years will automatically qualify for a GP service and it will not be necessary to hold a means-tested medical or a GP visit card.

Section 3 amends section 58A of the Health Act 1970 which sets out the existing GP service arrangements for persons over the age of 70 years to provide access to a GP service for all persons over the age of 70 years on a universal basis. Section 58A(1) establishes a new universal arrangement for the HSE to provide a GP service without fees for all persons aged 70 years and over who are ordinarily resident in the State. The HSE will also provide a GP service for the dependants of such persons where the existing income criteria are met. Subsections (2) and (3) outline the income conditions that the person over 70 years of age must meet for his or her dependants under the age of 70 to qualify for a GP service without fees. The dependant of a single person over the age of 70 years will qualify if the income of the person over the age of 70 does not exceed €700 per week. Alternatively, the dependant of a married person over the age of 70 years will qualify if the combined couple's income does not exceed €1,400 per week.

In general, the remaining subsections maintain the existing administrative practices of the GP service for persons over the age of 70 years. Subsections (4) to (7), inclusive, deal with the application process, the decision-making process and the provision of information. In line with current arrangements, subsection (8) requires the HSE to provide assistance for persons over the age of 70 years in making an application, if needed. Subsections (9) to (12), inclusive, address the income limits and the calculation of gross income. Subsection (13) provides that the HSE, in so far as practicable, will offer a choice of GP to the individual.

This legislation will deliver universal GP care to a second age cohort. By the summer, all 800,000 of the people aged over 70 years and children under six will be able to visit a GP without facing a financial barrier. The Bill represents another step towards a universal GP service for the entire population. I commend it to the House and look forward to hearing the views of Deputies on the other side of the House.

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