Joe O'Reilly (Cavan-Monaghan, Fine Gael) | Oireachtas source

I welcome the opportunity to contribute to this important debate. Primary care has been a key area of reform for the Government since it came to office. The quality of health care in any country is measured by its responsiveness to changes in society and the changing needs of the population. A Central Statistics Office report on population and labour force projections from 2016 to 2046 predicts that the number of people aged 65 years and over will rise to almost 1.4 million by 2046. More significantly, it forecasts a marked rise in the numbers aged 80 years and over, with the figure jumping to 470,000 by 2046. We cannot ignore these figures which highlight the fact that a strong strategy is needed to ensure we will have a quality health system in place well in advance of 2046.

The legislation before us represents a strong step forward in that planning process. Some 36,000 people over the age of 70 years currently do not qualify for free GP care. That is out of kilter with best practice internationally and among our European partners that, in most instances, provide free access to primary care. Section 2 of the Bill provides for the removal of all persons aged over 70 years from the means-testing process for free GP care. This section underpins the premise of the legislation and builds on the first stage of the implementation of free GP care for all citizens. In addition, free care is being extended to all children aged six years and under.

The Minister has indicated that both initiatives will be brought forward by the summer. I welcome this move which will see approximately 800,000 people aged over 70 years and under six being able to visit a GP without facing a financial barrier. I congratulate the Minister on his success in finalising the negotiations on a new GP contract. The majority of GPs have bought into the system, which is a very welcome development. GPs are central to the delivery of health services, functioning as the point of access for most patients. GPs enjoy the confidence of their patients and it is vital that they be properly remunerated and motivated. It is meritorious in itself that the Minister has managed to secure industrial peace, for want of a better term, between his Department and the majority of GPs.

One of the key components of the programme for Government is the undertaking to implement a phased introduction of universal free GP care. I am pleased to see that real progress is finally being made in this area, which will have a positive and reassuring effect on many individuals and families. It is progressive to seek to create a society where health care is related to need rather than income. I am very proud to be a member of a party which is pursuing that objective in government.

As I said, section 2 of the Bill which amends the Health Act 1970 will give everyone aged over 70 years an automatic entitlement to free GP care, removing the requirement to go through the sometimes lengthy process of means testing. A study carried out by the Irish LongituDinal Study on Ageing, TILDA, at Trinity College Dublin found that there was some evidence to suggest persons without a medical card or a GP visit card might face barriers when it came to accessing the flu vaccination. Any disincentive in this regard gives cause for concern and the Health Service Executive strongly recommends that those aged 65 years and older ensure they avail of the vaccine. Influenza can be fatal, especially for those with underlying medical conditions, which is common among many of the population aged over 70 years.

TILDA also identified a significant reduction in the numbers of people over 70 years of age with full access to primary and secondary care services at a time in their lives when their need for health care was increasing. Such services are especially important at the end of life. As people age, access to health care becomes all the more important but often more difficult to access because of means. If initial difficulties are not addressed, people may end up being hospitalised or needing nursing home care, with the associated expense. There will always be a cohort of the elderly population who require that level of care in any case, but early intervention by GPs may help to reduce the numbers.

The main barrier to accessing GP care is financial, particularly for the older generation. Many elderly people put off going to their GP and, as a result, their condition may worsen, resulting in a potentially greater cost of care. These are startling facts and make this legislation all the more vital. The key message of the Department of Health's primary care strategy, published in 2011, was that the overarching goal of Irish health policy was to provide a strong, effective health system that would focus on the delivery of services designed to keep people well and out of hospitals. This involves placing a greater focus on early intervention, health promotion and regular screening. Primary care centres play a huge role in this regard.

In Cavan-Monaghan there are between 48 and 57 GPs per 100,000 of population. This is, by no means, ideal, but it does compare favourably with the figures for neighbouring counties. Nevertheless, there is a need for constant improvement. GPS are at the coalface of the health service, working on the front line and, in so doing, earning the respect of the patients and communities they serve. They are usually the first port of call for those seeking to access health services. Removing financial barriers to access is extraordinarily progressive and will be of great benefit to hard-pressed parents of younger children, many of whom have a range of competing financial obligations, including mortgage payments, and to those aged over 70 years, most of whom are living on reduced incomes and must cope with a reduced cash flow.

According to a recent EU-funded study, strong and effective primary care is associated with better population health, lower rates of unnecessary hospitalisation and relatively lower socio-economic inequality. This finding was issued with the caveat that health expenditures were higher in countries with stronger primary care structures, which are, by their nature, costly. The bottom line is that investing in good health care services delivers long-term savings. In Cavan we have a very good network of primary care centres with state-of-the-art facilities, including those in Cavan town, Kingscourt and Bailieborough, as well as excellent services in towns such as Cootehill, Ballyjamesduff and Virginia. However, there is always scope to do more. I ask the Minister to ensure funding for primary care services remains a top priority for him and his Department as we budget for 2016. In particular, home help provision and back-up supports are vital for those who care for others in the home.

Section 3 of the Bill which inserts a new section 58A(1) in the 1970 Act puts in place a new legal arrangement which will ensure GPs provide a free-of-charge service for all persons aged 70 years and over and, where income criteria are met, their dependants. This means that in the case of a married couple, where one partner is under the age of 70 years and provided that their joint income does not exceed €1,400 per week - a perfectly reasonable figure and nobody could suggest there should be an increase in that threshold - both partners will access free GP care. There has been some criticism of the legislation to the effect that it will be of more benefit to those with higher means, with those with lower means losing out. Bearing in mind the threshold mentioned, that is hardly the case in this instance.

The service needs to be supported by restoration of the reduction in the respite care grant of €300 or whatever the figure was. There is a need for strong support through carer's allowance and ancillary benefits to ensure we have a good primary care system because if we have carers, we will have a good system.

I am glad to note that the allocation of discretionary medical cards increased by 56%, from 52,000 last year to 81,000 this year. That is positive. A mechanism must be put in place to give such cards to people with a chronic illness, illnesses that are extremely expensive to manage, and who find themselves in difficult circumstances. While probity and other proper processes must be maintained, the procedure must be made as simple and as accessible as possible.

We have achieved a lot in this legislation, on which we can only build. I congratulate the Minister, Deputy Leo Varadkar; the Minister of State, Deputy Kathleen Lynch, and the Government on making a very progressive start in this area of health service delivery.

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