Tommy Broughan (Dublin Bay North, Independent) | Oireachtas source

I am delighted to have a brief opportunity to speak on the Health (General Practitioner Service) Bill 2018. I thank the Oireachtas library and research service as usual for its fine analysis of the Bill and on its information on the key issues for carers.

It is a very short but important Bill. Throughout my career, I have tried to advocate as strongly as possible for carers and believe the tireless, unpaid work they do in large part still goes unnoticed and unappreciated by the State. Almost 20 years ago, when I was the social welfare spokesperson of the Labour Party, I published a paper entitled Caring for Our Carers, setting out a list of basic supports for carers which I believed at that time were very badly needed. Many of those supports still have not been delivered by successive Governments, including this one. One of the areas we covered at that time was the introduction of carer's benefit which was a very tiny step forward.

Census 2016 showed there were over 195,000 carers across the country, which was an increase of 4.5% on the 2011 census figures. Of these, as other speakers have said, just over 60% were women and almost 53% were in the 40 to 59 years age group. One of the most shocking figures in the analysis is that 3,800 children under 15 were providing care for a family member and almost 1,800 over 85s were also providing care, which was an increase of nearly 35% since census 2011. That brings home to us the situation that members of families often find themselves in. It is particularly poignant when elderly people and young children have to perform this crucial function.

As other speakers have said, the number of care hours per week was estimated, at full-time job levels averaging 38.7 hours per carer, at 6.6 million hours of care per week in total. Almost 43% of carers provided around two hours per day and almost 17,000 carers were providing full-time, 24-7 care. The figures available for June 2018 show there were 2,747 recipients of carer’s benefit and 77,384 recipients of carer’s allowance and that 83% of these recipients already have access to free GP care through access to a medical card or GP card. The Bill before us is expected to extend this care to a further 14,000 carers at a full-year cost of approximately €2.8 million. The Bill will provide for this extension by amending sections 47 and 47A of the Health Act 1970 and by inserting a new section 58D.

Ireland is the only health system in the EU that does not already offer GP care universally. Hopefully this shameful situation will end over the next number of years, either in this Administration or the next, as Sláintecare is implemented. It is regrettable, after the all-party approach of the committee, which included a number of Deputies all around the House under Deputy Shortall, the Government seems to be dragging its feet on the implementation of the programme. We may have made some improvements in that regard since the extension of GP care to under sixes but it is disappointing to see the Bill will not include those 29,869 carers in receipt of the carer’s support grant, which is the new name for the respite grant. Will the Minister of State explain why he did not ask for funding to extend it to those recipients given many of them are giving many hours of care per week to loved ones?

Carers experience a huge amount of stress and are more likely than the general population to become ill. According to the Department of Health, 27% of carers over 50 have reported high levels of stress and distress. The toll that caring takes on a person’s physical and mental health cannot be underestimated. Deputies know that very well because week in and week out we meet people who give an extensive part of their lives to caring for their loved ones, an older person or a child, or an adult of any age who has a serious disability or illness.

Section 4 of the Bill provides the insertion of section 58D, which I mentioned earlier, allowing for persons in receipt of either carer’s benefit or carer’s allowance to avail of a GP medical and surgical service. The Minister of State mentioned in his address to the Seanad on 5 July that section 4 included persons in receipt of half-rate carer’s allowance yet the informative Bills digest, which the library and research service prepared for us, tells us it is not explicit in the Bill. Perhaps it is something the Minister of State addressed in his opening statement. I was attending the Select Committee on Budgetary Oversight and did not get a chance to hear it. Will the Minister of State confirm in his reply whether persons in receipt of the half-rate carer’s allowance will also receive a GP visit card?

According to the library and research service’s excellent work, the half-rate carer’s allowance in Part 3, Chapter 8 of the Social Welfare Consolidation Act 2005 uses the term "a payment under section 186A" throughout and this Bill before us makes no reference to "a payment under section 186A". Is the Minister of State looking into this to ensure they will not be excluded?

Other important issues arise. What consultation did the Minister of State and Minister have with GPs? The EU average number of GPs per 100,000 people is around 91 yet Ireland has the far lower ratio of 64.4 GPs per 100,000 citizens. It is also reported that many of our trained GPs leave the country for opportunities outside of Ireland, mirroring trends of other health sector personnel, and it is estimated there will be around 26.2 million visits to GPs per year by 2031 due to demographic changes. Given this welcome Bill, do we need to offer new opportunities to citizens, particularly those from lower income backgrounds, to train as GPs and to give strong encouragement to work in Ireland?

Another issue that may arise with the Bill is related to data sharing and GDPR. Due to the nature of carer’s allowance and carer’s benefit, there will be monitoring of recipients' eligibility for those payments and therefore, by extension, eligibility for the GP card. The primary care reimbursement service administers this system and monitors eligibility but there may be data protection issues around sharing this information for the GP visit card. The Minister of State might come back on that.

National carers' week took place last month from 11 June to 17 June. I commend the work of all the advocacy groups such as Family Carers Ireland and others for highlighting the need for carers’ roles and contribution to the State to be recognised. The interesting points about carers, as Deputy Penrose and Deputy Murphy have said, is that virtually all of us will be cared for and all of us are, have been or will be carers. It is something every citizen understands. I echo the comments of my two colleagues. There is a deep-seated wish that carers are properly valued by the carer's allowance, the respite grant and all the other supports we can get them.

It can often be an isolating and tiring time and carers deserve to know that the national carers’ strategy 2012 will have resources put into it, so that their lives will be improved and they are supported. I hope the Minister has plans to update it in the current legislation. He may know that I am a member of the informal disability group of this Dáil and Seanad, as is Deputy Ó Caoláin, and a proposal has come forward from the committee for an additional programme of €211 million for supports for citizens with a disability, which would be helpful to carers as well. I hope the Minister will strongly advocate for this at the Cabinet table and demand that kind of money in budget 2019, and does not have to come into the House to tell us he only got €35 million or €45 million. It was a well-structured exercise to lay out the improvements we need in disability services and €211 million is a basic price tag across Government.

I welcome this Bill, I join with all our society in thanking carers for the work they are doing and I am delighted to be supporting the Bill. I hope that budget 2019 will bring some further improvements in supports and packages available to carers and I urge the Minister to put forward such requests to the Minister for Finance, Deputy Donohue, without delay.

There have been a lot of reports of over 70s contacting offices about the removal of medical cards, possibly on income grounds, and being given a GP card instead. A lot of people are upset about this and about what may be happening to the limits. It is not directly related to what we are talking about now but the Minister may examine the issue to see if there is a problem.

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