Pauline Tully (Cavan-Monaghan, Sinn Fein) | Oireachtas source

The Government is way behind many of the targets set to deliver Sláíntecare. It is failing in the delivery of universal healthcare and not making any significant advancement on affordability. Medical card eligibility, which my colleague has mentioned, has not been reviewed in two decades. For the majority of people, the thresholds have not increased in line with inflation and rising wages. In fact, the thresholds are so low that many people depending on social protection do not qualify. I know they will be given the medical card if they are depending on social protection, but their income on that level is so low that the threshold does not apply. I want to praise the people working in the section who deal with people applying for discretionary medical cards because they are very accommodating and helpful, and they take into account all the circumstances. However, it should be available to a lot more people. The thresholds need to be reviewed and increased.

The Government also announced plans in 2020 to expand free GP care for children up to and including the age of 12. It has since been legislated for under-eights, under-tens and under-12s but so far, it is only funded for children under eight. That is something that needs to be addressed without delay. The amount a person has to pay on the drugs payment scheme stands at €80 per month; it was €53 in 2001. That needs to be reduced. There are a lot of costs and people should not be out that much money on medication on a monthly basis. Automatic entitlement to a GP visit card for people on a median income should be applied as the uptake has been very poor. Accessibility and not just affordability is central to universal healthcare. More and more medical card holders are struggling to find a dentist or GP, making this entitlement worthless. I deal with constituents on a regular basis who, when their GP retires, have no GP to go to, or if people move home, they cannot access a GP service and must travel maybe an hour or more to actually visit a GP. With regard to dentists, again, I encounter people on a regular basis who cannot find a dentist who will accept medical card holders. I engaged with a constituent this week who has a cancer diagnosis and has undergone chemotherapy. Thankfully, she is in remission and doing well, but the chemotherapy has affected her teeth very badly. She has actually maximised the treatment available to her under the medical card. Perhaps there is something I can put to the Minister in writing whereby some discretion can be given to people who have undergone chemotherapy that has affected their teeth very badly so they would have access to more treatment under the medical card than is currently available.

Hospital and community capacity and workforce planning has not occurred. The Minister announced 1,500 additional hospital beds several times. They are not funded. As a result, hospitals continue to be overcrowded. The car parking charges have not been capped or removed despite promises to do so by the Government. Approximately 50% of the population continues to rely on insurance.

In his opening speech, the Minister mentioned mental health and improvements that have happened. However, I am currently engaging with families who are having great difficulty accessing health services, whether that is through CAMHS, in which there are ongoing problems, or elsewhere. There is also a fall-off then when someone in CAMHS enters adult mental health services. There is supposed to be more joined-up thinking in that area, but that is still not happening on the ground. There has to be co-operation. I know one young man of 19 who has attempted suicide twice. He did receive significant help from the CAMHS underage services team, but he has received practically nothing since. Even though he was promised a support plan, it has not materialised. Unfortunately, he attempted suicide and is in a psychiatric unit again. He is threatened with discharge, but he does not feel he has gotten any help and does not feel any different from when he entered. There are, therefore, serious issues. We need community-based supports. Hospital care and inpatient care is not the answer for everyone. We need robust community supports. He did not receive them. If he had, he might not be in hospital again being threatened with discharge. His parents and family are so worried. He is worried about where he is going to end up. He does not want to die, but that is where he is headed if he does not get the help he needs.

Sinn Féin has a health plan to deliver universal healthcare. In our alternative budget for 2024, we proposed an expansion of 400,000 medical cards, cutting the drugs payment scheme threshold to €50 and reducing,capping and working to remove car parking charges altogether. We would deliver a transparent framework of income-based entitlements that set out the path to universal coverage. We would reduce the need for private health insurance by investing in the public system, including the 3,000 hospital and community beds that are needed to make hospitals accessible. I received word from a hospital last week about a lady who is waiting for an appointment for extreme pain in her knee. The hospital received the referral and said that she is on the urgent list and will be seen in eight months. Eight months is not an urgent list. Again, that is something that needs to be dealt with immediately.

If Sinn Fein was in government, we would bring accountability for workforce planning to government level to tackle shortages of GPs and dentists and expand multidisciplinary primary care teams, which are essential components for improving access and providing capacity for universal healthcare. We would work North and South to plan and deliver accessible, affordable healthcare on an all-island basis, leverage the all-island population to deliver specialist services, end the need for outsourcing abroad and prepare for an all-island public health service. The Government is way behind many of the targets set on delivering Sláintecare. We need a new government with fresh thinking to ignite the process of delivering Sláintecare.

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