David Cullinane (Waterford, Sinn Fein) | Oireachtas source

Sinn Féin will support this Bill. I welcome in particular the provisions relating to medicines substitution protocols, which will improve the availability of products through pharmacies without a prescription. These are issues we have talked about for some time in the Houses of the Oireachtas. I have tabled a number of questions on this issue through priority and oral questions over recent years and have been raising it. I know the Minister has been working on this for some time, as have people outside of the Dáil who have lobbied very hard for changes in this area. There is more to be done in this space. I will come back to that in my contribution, but I welcome the provisions in the Bill.

The Bill, as we know, also makes provision to exclude income which is relevant to the rent-a-room tax relief from consideration of a medical card means test.

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Insofar as it goes, that is important and I welcome it.

I take this opportunity to raise wider issues relating to medical card eligibility and circumstances where I believe we can and should go further. The Government should have raised the medical card income threshold this year, but it also should have introduced a minor ailments scheme or what I would describe as a pharmacy-first model that would be underpinned by a minor ailment scheme, and much more. Instead, as we know, we have very limited additional funding for health in 2024. It is important to reinforce that at each and every opportunity we have this year to talk about expansion of healthcare. If the additional resources and funding are not there, then there are very limited options available to the Minister to expand services. We are pretty much trying to stand still this year when we actually had a real opportunity to accelerate what we are doing in many areas, particularly in primary care and community care in the context of pharmacies. We should build on the enhanced community care model, care in the home and care in the community and take the pressure off from our acute hospitals by providing the right care in the right place at the right time and so on. It is very difficult to do that, however, when we have limited additional resources available to the HSE. This all comes back to a decision that was made on budget day. I must also point out that Government has not reviewed the medical card income thresholds in 20 years. That is an incredible length of time for the Oireachtas and the Government not to have revised and improved access to medical cards. There has been some tinkering around the edges and some amelioration here and there, but in terms of substantial movement in this area, it has not happened.

I welcome the expansion of GP-only cards and doctor-only visit cards, particularly as I called for this. It is an important step. It was one of a number of things that needed to be done to reduce the cost of healthcare and move to a truly universal system. Some weeks ago, the Joint Committee on Health discussed the fact that there are difficulties with people understanding their entitlements and with making it available to people actually availing of it. I know that is something on which the Minister is working. I appeal to people to look at all of that, not just the income thresholds relating to the free GP card but also the other exemptions that go with it that could actually ensure somebody qualifies. Obviously, we want people to take up those opportunities. That is one part of it. I also agreed that we should freeze expanding free GP cards until we can bed in what is there and then also increase GP capacity further. We have to be conscious of pressures on GPs and we want them to do more to take pressure off the acute system. I was on board with that, which is why in our alternative budget this year we focused on 400,000 additional medical cards by increasing the income threshold by at least €10,000 per year. It was a better way to move on the issue of affordability and accessibility and making healthcare more affordable for people as opposed to more GP-only cards when we have the difficulties we have with even getting people to avail of the ones that are there.

As I said, I obviously agree with the rent-a-room relief and excluding this income from the medical card assessment. That will impact on a very small number of people, however, as important as it is. In our alternative budget, as I said, we provided for 400,000 additional medical cards. There has not been a review of medical card eligibility for two decades. Many people on what I would call very modest low incomes do not qualify for medical cards. As we also know, the medical card is a gateway to a range of primary and community care services. As a result , the more medical cards we can get to people, the greater access they have to primary and community care, which is one of the things we need to do, as I keep saying, to take pressure off our acute hospitals and ensure people are getting the right care in the right place. I also understand that none of this can happen overnight. I have been very honest about that as a lead Opposition spokesperson. All of these things take time.

I have also welcomed many of the moves that have been made in recent times, and I will do so again, including scrapping the inpatient hospital charges, additional free GP cards and the floor that exists in the context of the enhanced community care model. There are many teams providing support to people in the community, including integrated care programmes for older people, ICPOP, teams, community intervention teams and chronic disease management teams. That is really where we need to be at, and we need to be doing much more of that.

I have also to put it to the Minister that the recruitment embargo is impacting on chief officers in community services being able to recruit. An Teachta Ó Laoghaire has examples of this and will go through them later, but examples have been sent to me as well. Letters are being sent to staff in the healthcare service right across the board, particularly those in primary and community care, telling them their options of leave are now extremely limited because the services cannot hire staff to replace those who are leaving. That creates tensions within the system that really should not be there. I will make the point, however, that while I welcome the fact that we have finally moved with regard to an enhanced community care model, which the Minister put in place and for which I applaud him, there is an awful lot more we need to do. I am sure the Minister will agree.

I 100% support the moves with regard to medicine shortages. I have engaged with many people on this issue and have lobbied the Minister very hard in respect of it. I know that is something he was working on anyway. It is a really important step in this Bill today and I welcome it. However, I believe we are still only dipping our toes into the water with regard to what we can do with pharmacies. I again recognise some of the work the Minister has done this area, but there is an awful lot more we can do. I see GPs and pharmacies as comprising one of the most important gateways for people getting into healthcare. They are really important in terms of taking pressure off acute hospitals. I have always held this view. I have visited many hospitals over the last number of years as health spokesperson. I have probably been in every hospital at this point, and, I would imagine, some on more than occasion. I am very much of the view that if we continue to look solely at the problems and pressures in our emergency departments and hospitals through the lens of what is happening in those hospitals. If we just keep focusing on beds and surgical theatre capacity - these are all important and we do need to concentrate on them - we are never going to solve the problem. We have far too many people ending up in hospitals who really should be cared for elsewhere. There is a much broader issue that goes to care in the home and care in the community, but pharmacies have a role to play, and GPs have a greater role to play. We need to continue to find new and better ways of operating.

I share the Minister's concern that many dentists have still not signed up to the dental treatments service scheme. I appeal to them to do so. I appeal to them to treat medical card patients and engage in a process. I asked the Minister previously in good faith - we moved a motion in the Dáil - to commit additional resources. Those resources were committed. I am sure there is more that needs to be done. I know they are looking for a new contract, and there is a need for discussions in that regard. That is a matter for the Minister and the representative organisations. At this point, however, we have people who cannot access the service. I appeal to the dentists who have left the scheme to come back and engage because it is really important.

I have raised all the issues I wanted to raise. I will be supporting the Bill.

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