Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

There is no danger of that. I thank the Ceann Comhairle.

I very much welcome the Bill, which the Social Democrats will be supporting fully. It is an important move in the context of access to healthcare. Cost is a significant barrier to people accessing healthcare and it is very welcome that these charges, which can total €800 per year, are being removed. I have stated many times in the House that there is no justification for charging people for getting treatment when they are sick. There is no rationale whatsoever for doing so. It is very difficult to get into an acute hospital, as the Minister is aware. A person is admitted only if it is essential that he or she receives inpatient treatment. The idea of charging patients for that is outrageous. One would have to ask why it has been going on for so long. I welcome the fact that it is now being removed. This important issue arose when the Sláintecare plan was being drafted, however, and a number of measures were proposed, with timelines on them, for the removal of various costs that act as an inhibitor to people accessing care. It is important to point out that the proposal to remove inpatient hospital charges was to be implemented in the first year of Sláintecare, that is, 2018. Better late than never, but it is important to point out that it is coming in five years after it was first intended to happen. Nonetheless, it is a welcome move.

There are other hospital charges that are applied in a very unfair way, such as the €100 charge for attending emergency departments, EDs. I would like that charge to be removed but the reality is that the pressure on EDs is such that the intention of the charge currently is to encourage people to access services elsewhere before turn up at an ED. The problem is that the number of options in terms of alternative healthcare services to an ED are limited. Previous speakers referred to Caredoc, D-Doc and other out-of-hours services. The problem is that those services are wholly inadequate. Of course we should be encouraging people not to go to an ED if their health issue can be dealt with elsewhere but there are no options, especially out of hours. The minor injuries clinics are very good but 8 p.m. is probably the latest they stay open. Where else can a person who suffers an injury, such as a sports injury, go? Similarly, young children often get a very high temperature or other symptoms. The parents get very worried and need medical advice but, very often, that advice is not available.

It is very difficult to access medical care after hours. That is not a criticism of general practitioners, GPs, who are being expected to attend at night-time after they have concluded their normal surgery hours during the day. As it is an additional service being offered solely to comply with the GP contract and there is an effort to keep people away from those services, the services are not well advertised. That makes no sense. If there are alternative services, fewer people will present at EDs.

We need to look again at the option of having salaried GPs. There are many fully qualified GPs, particularly young female GPs, whom, for various family reasons, it does not suit to work in a practice during the day but who would certainly be available to work sessions at night-time on a contract or salaried basis. The Minister should pursue that. At one point, his predecessor was very much in favour of having salaried GPs. The contract for GPs is 40 years old. It is not suitable for the present day or to meet the needs of young graduates coming out of college who want to work in different ways.

First of all, they may not have the money behind them to set up in practice themselves. They want to work as part of a multidisciplinary team. Why are we not providing opportunities for those GPs to work here? Why are we forcing them out of the country to work in other healthcare systems? I ask the Minister to look at that idea of salaried GPs in order that we can facilitate those younger GPs who want to work on that basis. It need not threaten the existing GPs who are operating on the old contract and who have invested in their premises. They need not have any fears about that. We can have a twin-track approach, however. We can leave the existing ones with their existing contract if that is appropriate. Certainly, this is not a threat to their investments. However, we can provide opportunities for people who want to concentrate on providing health services and who are not really interested in the business end of things. I hope the Minister will look at that.

I also wish to refer to the consultants' contract. I congratulate the Minister on the work he has done. I have congratulated him privately but I want to do so publicly because it is a really good piece of work. I am very pleased to see the Minister is pressing ahead with that now. Again, it is another way of recognising the fact that time has moved on. Medical graduates want to work in different ways. Again, I will cite the research done by Dr. Niamh Humphries looking at the reasons hospital doctors emigrate. Money is down the list a bit. They want a decent work-life balance. They want to be treated with respect. They want to work in a system where they do not have to keep apologising to patients. I certainly hope that the new contract, which is very attractive, will attract back Irish graduates who have gone off to other healthcare systems. I hope the Minister will be promoting that very strongly and that as part of that, he will be aiming to give confidence to our medical graduates that things are going to change and we are going to see the much-needed reform and that the Minister will invite them back to lead that kind of reform. That is the kind of energy we need within our healthcare system. It is really important that we get that new blood back in.

Another point, which the Minister has raised, is the issue of the free contraception scheme. That is a very good scheme. It is very welcome. However, I ask the Minister to look again at the idea of contraception being available without a prescription, and available from pharmacies that are very happy to provide it. They want to be part of the solution. The Irish Pharmacy Union, IPU, appeared before the Joint Committee on Health very recently. It is keen to provide that additional capacity that is required. It is great for those women who qualify within that age group to be able to avail of free contraception. However, having to go to a GP and fork out €60 for a prescription just does not seem to make any sense at all. Will the Minister look at that?

I also want to ask the Minister where we are at with regard to the service plan. We are now at the end of the first quarter of the year and we have still not got the service plan for 2023. I know it is with the Minister at the moment. He expressed his desire to make some changes to it, as is his right. However, the delay is just unacceptable at this stage, three months into the year. There are many people working in services all around the country who are still waiting to hear about their allocation for this year. That is greatly hampering them for making plans, recruiting staff etc.

My final point is regarding GPs. The Irish College of General Practitioners, ICGP, told us very clearly that there is a problem with clinical placements and that is a factor in the difficulty in having enough GPs in training. I ask the Minister to look at that point again. I very much welcome this Bill. It is a positive move and we are happy to support it.

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