Verona Murphy (Wexford, Independent) | Oireachtas source

I am sharing time with Deputy Peter Fitzpatrick. No one could say anything other than that this Bill is welcome, but there are some concerns I wish to raise in order that we might ensure the success of its implementation for all concerned. The Bill provides for free GP care for under 13s on a phased basis. I would like to add a note of caution on its introduction date, phasing in and the balance of availability of services. The issue of availability of GP services is one of grave concern, particularly in Wexford. Evidence-based research from Trinity College shows that an increase of 28% in GP visits occurred with the introduction of free GP care for those under six years of age.

5 o’clock

When he was spokesperson in opposition, the Minister's response was:

This is a crisis. Doctors have been treated with contempt since Fine Gael came into power. It is about time there was meaningful engagement with GPs.

I am not trying to throw those words in his face, I say that because the situation has not changed. I appreciate that was then and this is now but that is why I remind him.

Take someone who moves from one part of the country to another, as many people in Wexford have done. Many of my constituents tell my office that they cannot get a GP to take them on. It is not the fault of the patient or the GP but it is something we must deal with urgently. People in Wexford are travelling back to Dublin weekly to get their prescription. The average number of patients per GP practice in Wexford is 1,118 while the national average is 861 so Wexford is over 30% above the national average for most practices.

A most concerning aspect for those unable to get on the books of a practice is that no one is collecting the data. We do not know the numbers. All the data is needed for any legislation. This is something that could be a question in the next census. GP practices are under huge strain and struggle to give the current patient list the care and attention required. They have no choice but to close lists to maintain cover and take on no new patients. Their staff are under great pressure to deal with patients requiring medical care, having to tell patients they cannot have an appointment within two weeks, which would have been thought outrageous once upon a time. GP practice staff would be enjoying their jobs were it not for the constant firefighting telling sick people they cannot have a timely appointment. The lack of new GPs to replace them means doctors are unable to retire from their practices, there is a serious shortage of locums if a doctor cannot attend his or her own practice. The State should consider a pool of locums under the HSE to assist in this, similar to the model used by the NHS in the UK.

If Covid has taught us anything, it is that this is a necessity. I encourage the Minister to get this under way as soon as possible. We cannot deliver legislation that looks like window dressing. Something that looks like that to me is the doctor-only GP card for those over 70 years who are not entitled to the full medical card. They are unable to access public health nurse services. Those over 70 years are a vulnerable category. If, say, they only require dressings changed once a week, it is much better that it be done by competent public health nurses than require a GP. It should be expanded because eligibility should be based on need not age.

In 2018, the Irish Patients Association said that 1,310 new GPs would be required to keep pace with the expected rise in consultations from the implementation of legislation for those under six years. I have tried to find what stage we are at with implementing that or furthering our GP services, including how many have qualified or are in training. Based on the phased implementation of this for those under 12 years a considerable increase in GPs is needed, rather than continuing with the overwhelmed services which cannot continue. In healthcare patients should receive the care they need. Doctors' primary focus is to deliver timely, high quality care as much as possible for healthy outcomes.

I wish to emphasise the cuts to disability services which has already been raised. Some €20 million was cut from the disability budget a year after we adopted the Convention on the Rights of Persons with Disabilities. I visited the Cumas centre in New Ross. Cumas means ability and capability. Though a disability service, it never uses that word. I was in awe of how it conducted its services during Covid. It never missed one hour of support for its residents. Its service is about providing supports to enable the ability of its residents and clients and that gives them choices in what life has to offer them. I was saddened about the 1% efficiency cut through the HSE that will come into operation in January. Previously, the Minister said that could not happen. I plead with him not to cut funding for these people who do unbelievable work on all our behalf. I ask that he not cut funding which will inhibit their success.

Home care services have also been raised today. Wexford is not on the community intervention team, CIT, services and badly needs to be placed on this. It is virtually everywhere else in the country except Wexford and we need it, particularly because our GPs are overwhelmed. The community intervention team provides services, enhancing overall primary care, providing access to nursing and home care supports from 8 a.m. to 9 p.m. seven days a week, but the service does not operate in Wexford so its GPs cannot refer people to it. Once again, home care hours cannot be provided unless someone dies. I am ashamed to say that in this day and age. How can we establish eligibility criteria that is not based on need when others cannot be provided the service unless someone dies? I understand the Minister is new in the job but he addressed these issues down through the years in opposition. I ask that he continue to do so now.

Finally, I commend all the front-line workers in Wexford, including those outside of the public health system, public health nurses, home care workers and everybody who provided services throughout the Covid crisis and who continue to do so. I hope the Minister will fight to ensure the promised increase in their salaries is honoured when the time comes.

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