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

I welcome the opportunity to contribute to the debate on the Health (General Practitioner Service) Bill 2015. The health of citizens is always a priority issue for me and an issue on which we all should focus. Reform and investment must be at the heart of this and related debates. We have all seen the devastation wrought on the health system in the past five years as a result of cuts to services. These cuts have inflicted great pain on families and were totally wrong. Notwithstanding the economic recession and the so-called difficult decisions the Government had to take, the reality is that poor choices were made and many of them were easy and lazy ones. Different choices could have been made which would not have affected the sick, the elderly and the disabled.

That is my bottom line in the debate, a focus on those most in need. We must not try to con people by saying that if they want a decent quality health service, they have to pay for it. Those with the most in society should pay for it through fair and equitable taxation. I support the introduction of a universal health service which is part of my vision for the future of the country. The Minister of State may have heard the observation some days ago made by Mr. David Hickey, a former Dublin footballer and former consultant and transplant surgeon at Beaumont Hospital, that we needed a health service run by people who cared. That is a fundamental principle we all should support. Unfortunately, the transplant unit at Beaumont Hospital which was led by Mr. Hickey has been closed down. That was an appalling decision.

A pressing problem within the public health service is the fact that 88% of final year medical students have indicated a desire to move abroad for work. That is another scandal. We are spending millions in training medical students only for the majority of them to think about emigrating. I recall during a holiday in Havana some years ago meeting a group of local medical students who told me that part of their training involved going to mountain villages during their summer holidays to work with the poorest members of society. After qualifying, they dedicate their services to their own country. In addition, many of them volunteer to travel internationally for a time to help people in other poor countries, particularly in Africa. That is the type of vision and emphasis on caring I would like to see in the health service. Many people have been very greedy in the past ten or 12 years. People in some sections of society have lost the run of themselves entirely. The Bill represents an opportunity to address some of the deficiencies in the health service. I accept that the legislation is part of a broader reform effort, but we need to act very quickly if we are to ensure there will be meaningful change. As well as improving efficiency and standards for patients, we also must ensure we have proper working conditions for medical students and the staff who work crazy hours in emergency departments.

The importance of primary care to the overall health of the population is recognised, both nationally and internationally. The World Health Organization identified primary care as the key to the attainment of the goal of health for all. Ireland is unusual in Europe in having GP fees. In many other OECD countries, by contrast, primary care is either free or heavily subsidised for most of the population. If we want to have a good health service, we must ensure we have the resources to pay for it. That does, of course, require a sustainable economy, but the bottom line is that those who have the most in that economy must make the largest contribution. That is necessary if we are to have a fair and just society. If we dig deeper into the issue of medical card provision, we see the number of medical card and GP card visits has grown substantially in recent years. On 1 January 2015 there were 1,928,276 medical cards and GP cards in circulation, covering approximately 43% of the population. That represents a sizeable increase of more than 570,000 over the 2007 figures, when there were 1,351,717 cards in total. The increase is directly related to the lower incomes and higher levels of unemployment in recent years.

I immediately welcomed the decision to extend automatic entitlement to free GP care to all over 70 years. Many of us in this House have argued for the implementation of universal health insurance as a matter of priority and the provision of free GP care at the point of use. However, many in the medical profession - the Irish Medical Organisation, IMO, in particular - point out that GPs are overstretched and under-resourced and priority must, therefore, be given to the provision of services for those most in need. I agree that the elderly, the sick and the disabled, both children and adults, must be given priority. The International Monetary Fund recently recommended that Ireland reduce its social expenditure through the means testing of benefits and taxing of universal benefits. We must be very cautious of the advice coming from some quarters. I understand the cost of implementing free GP care for the cohort of persons identified in this legislation is estimated to be in the region of €18 million per annum, with €12 million allowed for in 2015.

Turning to the Bill, its purpose is to amend the Health Act 1970 to provide for a universal general practitioner service to be made available without fees to all persons aged 70 years and over. In addition, it provides that dependants, including the spouse or partner, of a person aged over 70 years will have access to a GP service without cost and where the existing income qualifying criteria are met.

Section 2 amends section 58 of the 1970 Act to remove all individuals over 70 years of age from the scope of the means-testing requirement for the provision of a medical card or a GP visit card. Instead, all persons in that age bracket will qualify automatically for a GP service.

The new section 58A(1) of the 1970 Act, to be inserted by section 3 of the Bill, establishes a new legal 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 and to provide such a service for their dependants who are ordinarily resident in the State where the income criteria are met.

That is what the legislation is about and it is important that we examine the details.

Regarding data for GP fees, sadly, such information is not routinely collected. However, the findings of an informal check carried out by the Competition Authority in 2008 suggested the cost of GP care in urban areas was between €50 and €55 and slightly lower in rural areas. In 2009 it was stated in an ESRI research paper by S. Smith:

Private charges for GP visits are approximately €40-€60. The charges vary by GP, but can also vary by visit and can be hard to predict in advance.

In 2009 the Competition Authority, in highlighted the rising cost of doctor visits and its impact stated:

The cost of visiting a GP has risen rapidly in recent years, significantly outpacing the general rate of inflation in the economy. There are indications that a substantial number of private patients are delaying GP visits due to cost factors and are "shopping around" for cheaper consultation fees.

That is the evidence, in respect of which we must be very careful. That is the reason I welcome the legislation.

The Minister for Communications, Energy and Natural Resources, Deputy Alex White, a former Minister of State at the Department of Health, stated in a contribution in the Dáil:

The evidence is clear that people delay or avoid visiting their GP where a fee is required. Removing this cost barrier will mean that ... [citizens] will be far more likely to address medical problems at an earlier age, leading to better outcomes and treatment that is of less cost to the State.

Better outcomes and early intervention are important because they are not only good for the patient, they also assist in dealing with the cost issue. I accept that the cost of medicines is a major problem. I also accept the reality that it is very difficult at times to deal with the pricing issue.

Nine out of ten people in the relevant age group have a medical or a GP visit card. Those who will gain a GP visit card under the Bill have incomes above the current means test limits, that is, a gross weekly income of over €700 for a single person and over €1,400 for a couple. To qualify under the Bill, people have to be aged 70 or over and ordinarily resident in the State. These conditions must be verified to the satisfaction of the HSE. The Bill provides that the HSE, as far is practicable, will offer a choice of GP to eligible persons.

Overall, I welcome the debate on the Bill as it is important that we deal with the real issues. We must have priorities and introduce reforms. We must have a vision for the health service and point out that if people want a quality health service, they must be prepared to make a contribution. Those in society with the most should pay the most. Even those in the wealthier sections of society know that is the reality. They know that they would do the State a service in distributing some of their excessive wealth in a fair and just manner.

I totally agree with Mr. David Hickey in his view that we need a health service run by people who care. That is the extremely important aspect. I would apply the same principle to other services, whether it be disability or education services. We need to have the right people going into professions. I do not buy some of the arguments that the reason a patient is left lying on a trolley and not looked after has to do with resources It also has to do with having people on the front line. Neither do I buy the argument that what happened in the case of those working with people with disabilities, for example, in Áras Attracta, had to do with resources; it had to do with the quality of people involved. We have people who care. I have met many of them, as I am sure has the Minister of State. There are examples of great practice in the health service. We have top quality people in front-line services and need to give them a break. We need to improve their working conditions and ensure the necessary investment is made for them and that the necessary resources are provided. I welcome any increase in funding for health services. I know that the Minister of State will have the support of many of us on this side of the House in trying to deal with these issues. It is difficult at times when one is arguing with others who want to see tax cuts or give away money and do the popular thing, but it is a time to be brave, to have a vision and courage. It is a time to stand up for the health service, to stand by the staff who work in it and, above all, to ensure patients are looked after in a professional and caring manner.

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