Joan Collins (Dublin South Central, Independents 4 Change) | Oireachtas source

The Minister would have had a hard job ahead of him even without what has happened internationally with the pandemic, which has caused a catastrophe in our health services and across the world. This is mainly because of decades of not mismanagement but an ideological move away from public healthcare and removing money and resources from it while moving towards the private health sector.

Today we are looking at a Bill that deals with two aspects of budget 2020 proposals as agreed. These are that the Government is to extend free GP care to children under the age of eight and to provide free dental care to children under the age of six. This was to be brought in by September 2020. Is that free dental care for children under the age of six included or when will it be brought in?

The budget also proposed to increase the medical card weekly income limit for a single person over 70 by €50 to €550 and by €150 for a couple to €1,050 from July 2020. The prescription charge for medical card holders was to be reduced by 50 cent, bringing the charge to €1.50 per item for those under the age of 70 and to €1 per item for people over the age of 70. This was to be introduced by this month. I have had several people on to me who found this change was not brought in by their pharmacies and they were charged at the current rate. The pharmacists in these cases claimed they were not instructed to make the change. When will this happen?

The budget proposed the monthly threshold for the drugs payment scheme would be reduced from €124 to €114 to be brought in by September 2020. Will it still be brought in then? The number of home care hours in 2020 is to increase by 1 million. We were all critical of that figure when it was announced, including the Minister, because it only brings the hours back to where they were before they were cut. How many hours will be provided to meet that increase?

The HSE will review and extend arrangements for the provision of the discretionary medical card to those with a terminal illness. Where is that at now? That is a big issue and we have had to deal with several cases of people who were turned down for a medical card when they were terminally ill. What extended arrangements are being put in place for the provision of discretionary medical cards?

The budget proposed that, to reduce patient waiting times, funding for the National Treatment Purchase Fund, NTPF, would be increased by €25 million to €100 million. In principle I do not agree with the NTPF because we are transferring public money to private hospitals when we should be bolstering our public hospitals to deal with these cases. I understand people will use the NTPF because they have been waiting for so long for treatment. It makes a joke, however, of trying to implement Sláintecare. It is the same with the cross-Border health directive.

Many of us, including the Minister, were on the Sláintecare committee. Much time and energy went into that and its proposals were put out three years ago. Deputy Shortall raised the point that free universal GP access was to be brought in by 2025. That is only in two years' time and we are only at this point. A criticism of the previous Government's implementation of Sláintecare was that it was doing so in parts. I raised with the Business Committee before Covid restrictions came in that we should have a review of the Sláintecare programme because matters have moved on so much. We should get the Trinity College Dublin experts in to explain why such and such has not happened and how do we move it on. It does not have to be a six-month or eight-month review, just a short one.

GPs will be asked to take on 300,000 extra children which is quite a big cohort. I accept they will not be all walking through the door on the same day but it is a big ask. We cannot get definite figures of how many GPs are operating in the country. There are different figures from the Medical Council of Ireland and the Irish College of General Practitioners. A comprehensive register of GPs has to be set up. The previous Minister found it difficult to get the GPs contract in place. That will be crucial. GPs should be salaried to take the private aspect out of their work and push them into primary care centres. Some 2,498 GPs signed up as family doctors, up seven since the start of 2019, a minuscule increase. There are not enough GPs on the ground.

At the Sláintecare committee several years ago, we were told 666 GPs were due to reach retirement age and 27% of GPs were over 60. We have not seen a targeted campaign to get more people into GP training. That is urgent. We should be promoting GP services, informing doctors that they will get a reasonable salary. I have put in many parliamentary questions on this over the years on finding out GP numbers in training and the increases are not dramatic. Many who come out of training go abroad which is another issue. Can we think outside the box in this regard? As we are in such a crisis, can we say to students that the State will pay for their training but on the condition that they stay in the country for at least ten years after graduation to pay the State back? Can we point out to them that they will get valuable experience with experts, work in a primary care units and so forth?

I had many contacts from people saying they were breathing a sigh of relief that they could get their hair cut, yet people cannot access vital health services to save lives. I know this is difficult. During Covid, I was amazed at how health service workers working together were able to move mountains. They were able to set up a hospital to deal with a surge which did not happen, thankfully. Those are the people who can tell the Minister and HSE management what needs to be done. The "Prime Time" programme last night highlighted the need for hospitals. We need to prepare for a possible second surge of Covid. We need to be able to expand Covid services again if needed. How, in the meantime, can we utilise our hospitals properly for day-to-day services and surgeries? If we do not do it and get a second Covid wave, it will be another six months that people will not have the services they need. That is not something we want to contemplate.

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