David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I welcome the Minister and commend the publication of the Bill. Any measure that reduces the cost of healthcare for any citizen is obviously to be welcomed. I also support and welcome the introduction of free contraception for women aged from 17 to 25 years. I commend the Minister on the very good work that has been done over the last year on women's healthcare, notwithstanding differences we had on the national maternity hospital. I accept that we have seen some significant changes in recent times in this area, on which much more needs to be done.

Three principles should underpin all of our approaches to healthcare, the first of which is accessibility. We all know the challenges patients face in accessing healthcare at every level, including long waiting lists, which are unacceptable in many different areas, long waiting times in emergency departments and people waiting longer to access a GP. All those access issues are very important, as are affordability and accountability.

Affordability and accountability are linked, as I will explain to the Minister. While the measures the Minister is introducing in this legislation are welcome, they are only baby steps towards achieving what is needed to move to a single-tier health service and universal healthcare system. We are a long way away from realising many of the big commitments that have been given, for example, universal GP care for all citizens. We have more to do even with regard to the inpatient hospital charges. The measure in the Bill relates to children only and should be abolished for all patients. We have the issue of car parking and prescription charges. The threshold for the drug payment scheme is still too high, although it was reduced in the previous budget. An awful lot more needs to be done to reduce the cost of healthcare. For me, however, the biggest issue is realising the objectives of Sláintecare and getting to a point where we truly have healthcare delivered free at the point of delivery, inasmuch as we can and certainly in primary care and acute care. We have a long road to travel.

The Minister and I have a difference of opinion on whether there is a need for an emergency budget. In the past few weeks, the Minister and the Government have introduced legislation to provide for commitments made in the previous budget. The Minister gave commitments in the budget last October that he would roll out contraception for women in this age group and that children aged six and seven would have access to GP care. We are still waiting for that. Other commitments were also made last October. In the most recent round of cost-of-living measures, provision was made to reduce the cost of inpatient charges. However, many of these measures take far too long to be brought in because of the contractual issues that must be negotiated to realise and deliver some of these issues.

Today, we heard that Electric Ireland is to increase its prices by at least 10%. Inflation will also hit 10%. Obviously, everything we can do to reduce the cost of living for families is very important, and healthcare is obviously part of that.

We are concentrating today on children and the abolition of hospital charges for children. A wider piece of work needs to be done regarding the cost of a child being sick. This is an issue the Minister raised when he was in opposition and it is one on which I would like to work with him. I have met many groups that represent parents of children who were in hospital for long periods. This gives rise to significant additional costs. The cost of overnight accommodation is sometimes provided for in hospitals and sometimes not. When parents have to take time off work they have no entitlements, which is very difficult for them. We need to look at the cost of a child being sick and do much more for the families of children who find themselves in that position. As parents, the Minister and I know that when a child is sick, parents want to do everything possible to support their child. They should not have to worry about all the costs that go with that, which, unfortunately, many parents do. A huge amount more needs to be done in that area.

The Minister mentioned the rolling out of free GP care for seven- and eight-year-olds, which is welcome. However, he added the important caveat that we do not know when that will be implemented. That is part of the problem. This measure has been announced and announced again. This House passed legislation that enabled all children aged under 12 to access free GP care. We have not even got past those aged eight years and under yet because the Minister is still stuck in negotiations with the Irish Medical Organisation.

As somebody who wants to be in his position one day and who will have to answer, I am sure, similar questions on how quickly we deliver all these objectives, I say to the Minister that we will never deliver or realise universal free GP care unless we increase capacity and have a plan to increase training places. While I know that has and is being done, we must do more. We must also put in place a new, modern contract for GPs that reflects a modern practice. If we do that and put in the architecture and foundations, we will be able to expand universal GP care more quickly. I would like to see a long-term plan negotiated with the IMO, one that provides a new contract and sets out what we are going to do and the direction of travel. The quid pro quowould be that the IMO must sign up to a realisable objective of getting to universal GP care for all, rather than having these piecemeal negotiations by month or by year in which we do not get anywhere. The caveat that has to be noted is that the Minister cannot tell us today when this measure will be delivered. It has been announced and announced again, which, unfortunately, is just part of it.

I also wish to deal with the issue the Minister raised about innovative medicines and the reimbursement process. I have engaged with many people who work in this area. We are very fortunate that we live in a country in which many of these high-tech drugs are made. Huge innovation has been achieved in the pharma sector and healthcare generally. I am blown away when I visit some of our hospitals and training colleges and see the innovation and talent we have right across our health services. We see it also in innovation in new technologies, drugs and medicines, in which Ireland is a leader. We are not always a leader in those drugs being made available for patients, however. The Minister is right that more medicines have been made available in recent times and that more funding has been made available. Funding is part of this.

The reimbursement process is very cumbersome and takes far too long. I know the Minister's staff and HSE staff tear their hair out when they see the number of parliamentary questions Deputies submit week in, week out. We do so because we want to get information and understand how processes work. I tabled many parliamentary questions recently on this issue to better understand the process. It is really cumbersome and needs to change. Funding is part of it but how we arrive at that decision is also part of it.

The Minister will be aware that Kaftrio, the drug for children with cystic fibrosis, is one issue on which parents are campaigning. I know we can come in here every week and talk about some drug. There will always be a drug that is contentious and that will be part of a hot political debate. We cannot do everything but this is obviously an issue that, again, has understandable traction because these children will benefit from it, yet it is still stuck in the process. We do not know when a decision will be made on that particular issue.

We have an awful lot more to do to reduce the cost of healthcare. I do not believe there is a roadmap in place for delivering a universal healthcare system.

In the replies to all the parliamentary questions I put to the Department asking how much it is going to cost to remove private healthcare from public hospitals, I am told the Department does not have the costs, it is too complicated and the Department does not have the formula to work it out, yet this is an objective of the Oireachtas as part of Sláintecare. When I ask how much it will cost to deliver universal GP care for all citizens, I am again told the Department cannot cost it and does not know how much it will cost. If the Minister says that information is available, he should provide it to me. I can send him at least 50 replies to parliamentary questions I have received in which I have been told the Department cannot provide a cost. I will send every one of them to the Minister so he can see I have tabled these questions time and again. I have asked the question in many different ways and I cannot get a costing. I am told we have to look at demographics and increased demand. That is all true, but that work should be done. What is more difficult for me is there is no timeframe when I ask what the timeframe is to realise this.

These are issues on which I would like to work with the Minister because regardless of who is in his office these are the big issues that have to be delivered. An accessible, affordable and accountable healthcare system is one we all would like to see.

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