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

It is my pleasure today to conclude the Dáil legislative process for what is a significant and important Bill. This Bill will provide for a universal GP service to be made available to all persons over 70 years of age and builds on the first phase for those aged under six years. Under the Bill, access to a GP service will be provided to all persons over the age of 70 years on a universal basis, replacing the existing GP service arrangements for those aged over 70 which is based on a means test.

Their dependants, including spouses or partners who are under the age of 70 years, will continue to have access to a GP service without fees where they meet the existing income limits. The decision to prioritise the over 70 cohort for the roll-out of the universal GP service had regard to the significant prevalence and comorbidity of chronic diseases in the population aged over 70. It is estimated that about 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. The annual cost of the system for those aged over 70 based on existing GMS GP costs is estimated at €18 million.

It is important to be clear that nothing will change for any persons over 70 years of age who have or are eligible for medical cards. They will continue to receive all of their other medical card entitlements as normal. The Government remains committed to the introduction of a universal GP service for the entire population, in line with the programme for Government. We are in the process of re-orientating the health system to one that only treats sick people to one that keeps people well.

The Government is 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 and not their means. While we are making progress on universal access to GP care, we also recognise 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 and make it more sensitive to people's needs, especially where serious illness is involved. The medical card system is now operating in a more sensitive and sensible manner. Greater discretion is clearly being exercised by the HSE and the number of discretionary medical cards in circulation has increased by about 56%, from about 52,000 in mid-2014 to more than 85,000 at the beginning of this month.

When someone meets the crisis of a serious illness at any stage of life or a child develops a serious illness, one may be in a financial position to meet one's immediate needs or have those needs met by the hospital system. In general, that is what happens in Ireland and we all agree that the problem is access in terms of the health service. Once one is in the system and being treated, it is second to none, apart from the mishaps that often occur. We are not the worst in the world and most people, when they come out of the service, will say they have had a very good experience. The normal reaction of those who have been ill or their loved ones is that the service is good and responsive once one is in it.

We need to get away from the immediate instinct to go to accident and emergency in an acute hospital because that is where difficulties occur. People who are doing their very best to deliver a service often find themselves having to tell people that they should not be there in the first place. Access to a GP will ensure that we have a more defined delivery of care. It is about staying healthy, rather than concentrating on ill health. Universal access to a primary care system is not just about GPs; rather, it is about care as we age, for very young children or people with long-term chronic diseases.

Primary care is about recognising that one does not always need to go immediately to accident and emergency. Our aim in health should be keeping people well, as well as right across the board, in terms of paediatrics, gerontology, mental health and physical well-being. I have said many times that in the recent past that people did not have a great interest in mental health and that is why A Vision for Change garnered universal approval. I am not certain which one of us read it in any great detail in terms of how it would deliver a service but surely if we can agree on the principles of what we want from health, we can also agree a pathway to ensure it is delivered.

This Bill will deliver universal GP care to the 36,000 persons aged over 70 who do not at this time have access to a medical card or a GP visit card. By the summer all 800,000 people aged over 70 and under six will be able to visit a GP without facing a financial barrier, which will be a significant step towards a universal GP service for the entire population. I commend the Bill to the House.

I know the House will be interested to hear that as of now well over 50% of doctors have signed up to the new contract. I have no doubt that there will be issues, but what system is perfect? We are convinced that by the end of the summer we will have those aged over 70 and under six covered. The sign up for those aged under six and over 70 will begin on 1 July and 1 August, respectively. There is an issue of timing to ensure that the system can cope.

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