Billy Timmins (Wicklow, Independent) | Oireachtas source

It is easy to support this legislation. I like to think that people on this side of the House take a progressive and pragmatic approach to legislation. However, while I support the Bill, it does raise issues. A number of years ago when driving in by Dolphins Barn one Tuesday morning, I saw a nice big yellow sign which promised free GP care for all. I felt a little sick on seeing it because, as we all know, nothing is free. There is a cost for everything and somewhere down the line somebody must pay. It is important to try to market our policies correctly, but rather than try to be populist, we should be open about the consequences of such a policy.

I have a concern regarding the concept of universal benefits, be they third level fees, health care or something else. I could pick at this legislation and ask whether it is fair any billionaire over 70 would have free GP access while somebody younger in financial difficulty who is just over the qualifying limit cannot have that access. However, in the area of health, more than elsewhere, the argument can be made that by providing people with access, we will save money in the long term. I have listened to some of the figures trotted out suggesting that people who have to pay for GP visits are less likely to visit the doctor. Perhaps the corollary of that is that people who have free GP cards are more inclined to visit GPs and waste their time. I know from GP practices around the country that many of them are frequented by the same people all the time.

I am loath to comment here at times - due to the use of social media and the fact there are so many people with little to do except to put their comments on the Internet or on Twitter - without giving an introduction, a preamble and a conclusion. Nevertheless, I would have been a supporter of the basic charge for prescriptions, not as a means of raising revenue but as a means of ensuring respect for the service. In general, people do not appreciate what they get for free, be it unearned rewards they receive financial or otherwise. We should look at a basic charge for prescriptions, for example a €1 charge or one linked to the consumer price index.

This legislation has been welcomed by most bodies, but I understand it was not welcomed by the Society of St. Vincent de Paul. One can always pick out a weakness in policy and consider that money could be better spent. However, in principle it is a good idea to give people access to medical facilities, particularly in the context of prevention. I understand this measure will cost in the region of €18 million. This is a small amount in the general scheme of things and will provide for 36,000 people. Some 10% of those over 70 do not currently have free GP care. While this legislation does not deal with children under six and I have not seen any costs in regard to providing this access, I am not as comfortable with the idea of providing free GP care for those under six as I am with providing it for those over 70. Other speakers have referred to free GP access for children under six and currently approximately just over 40% of those under six have that access.

Recent research showed that during the economic downturn people were less likely to visit GPs and it has been suggested this may be due to GP fees. There is huge diversity in fees charged across the country. People in both the public and private sector have taken a hit in their wages. I note that at the public service reform and innovation conference today, the public sector declared an increase in productivity will not be part of any deal. I am not sure what hymn sheet the Minister for Health, Deputy Varadkar, is singing from currently, but he seems to be caught between two stools. He will suggest there must be increased productivity as a result of this legislation. We must all, politicians included, put our shoulders to the wheel.

I believe it would make life easier for people if they saw a reduction in the cost of services. Accountancy fees have been reduced, but legal fees have not. I do not believe there have been any radical reductions in medical fees. Much of the reason for the failure to reduce fees is the lack of competition and the existence of monopolies. Wherever we find monopolies and a lack of competition, it is hard to drive down fees. If people saw a reduction in energy fees or insurance costs, it would be easier for them to accept a reduction in their wages. However, if people's wages are reduced, but the cost of services remains the same or increases, it is difficult for them to accept lower wages. On increased fees, I notice the clampers in a hospital in the Minister's area are seeking to increase clamping fees from €80 to €120 or €130. However, I have often thought parking or speeding fines should be reduced, unless there is clear evidence they act as a deterrent and ensure better road safety and smoother traffic flow.

There is not much to be said about this legislation as it is straightforward. Many people raised constituency issues and examples. It is important to recount these as these accounts inform policy. We can talk about health services and funding, but we must be prepared to recount the stories of those we meet who have had bad experiences. Few of us talk here about good experiences. Human nature being what it is, we are not inclined to articulate those experiences. Deputy Durkan is a strong advocate of pushing issues that illustrate wrongs and we all work on the basis that everything else is working smoothly.

I wish to raise the issue of an educational course provided in Britain for people in the medical profession, consultants and doctors, who must relay information, particularly bad news, to clients. Time and again I have met people who have been dealt with in an insensitive manner. This is understandable where there may be a language difficulty or where the doctor or consultant is under pressure. However, each case is individual to the patient or his or her family. I would like to see the Minister bring forward some proposal in this regard. A number of years ago we had a patients' charter, but I do not know whether it had any provision for this. Perhaps we should look at what has been done in Britain and arrange a seminar. We should ensure that when information is being relayed to people, particularly on occasions when people are being informed of a terminal illness, they are given privacy and dealt with in a sensitive manner. This happens in most cases, but not in all. Insensitivity can leave a terrible and negative impression on service users, yet this is an issue that could be dealt with quite easily.

I am aware of a case in Waterford where an individual waiting to see a dermatologist has been on the waiting list since 2007. I have not got to the bottom of this issue yet. I have been told there is a shortage of dermatologists and that interviews are due to take place. Eight years is a long time for someone with a skin problem to be waiting.

4 o’clock

Deputy Naughten referred to the issue of capacity. I do not know what impact this will have on capacity but GPs are under a lot of pressure. The Minister will have heard their stories at their conference last week. Hacketstown in Carlow is across the border from me. A GP there has given a lifetime of service and he is finishing up at the end of this week. He covers a rural area in Wicklow and Carlow. It may be very difficult to find a replacement for him and there may be pressure on his replacement to move to a more populated area with a primary care service with extensive facilities. I am a strong advocate of the primary care concept but this should not be at the expense of the rural-based doctor. People in rural communities like the doctor to be based locally. They do not want to be travelling 15 or 20 miles to a primary care centre. It is not possible to have a doctor in every parish but if a rural population can support the service then pressure should not be put on the doctor to go to the primary care centre. I refer to the monopoly situation where the GP has control over the medical lists and the new GP is unable to access it. I ask if the Minister plans to address that issue.

Much good work has been done in the health service but I note a situation which affects my constituency and also parts of south Dublin. I refer to the STEMI centre in St. Vincent's hospital which provides emergency care for cardiac arrest. It seems that it has been decided to close the unit with effect from this Friday. This leaves two units, one in St. James's Hospital and one in the Mater hospital but people from south Dublin or the east coast will have to go to those hospitals. I hoped to raise this matter as a Topical Issue on budget day last year but it was deferred. I have been trying to ascertain the situation from the HSE. The Minister may not be familiar with the situation but it would be catastrophic to close it. I am glad to hear it is not a funding issue-----

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