Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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80. To ask the Minister for Health if he has now abandoned the commitment to extend free general practitioner care to all, commencing with long-term illness patients; and if he will make a statement on the matter. [22734/13]

Alex White (Dublin South, Labour)
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The Government is committed to introducing on a phased basis a universal GP service without fees within its first term of office, as set out in the programme for Government and the future health strategy framework. This policy constitutes a fundamental element in the Government's health reform programme. There has been no change to the Government's over-arching commitment to this goal. This Government is the first in the history of the State to commit itself to implementing a universal GP service for the entire population.

Having examined the progress made in the universal GP care plan, it became clear that the legal and administrative framework required to provide a robust basis for eligibility for a GP service based on having a particular medical condition is likely to be overly complex and bureaucratic for a short-term arrangement. Relatively complex primary legislation would be required in order to provide a GP service to a person on the basis of their having a particular illness. The assessment system for such an approach would have to be robust, objective and auditable in order to have the confidence of this House as well as the general public. This legislation would have to address how a person could be certified as having such an illness, who could do the certification and how to select the diagnostic basis for medical conditions. As well as primary legislation, there would be a need for secondary legislation to give full effect to this approach for each condition. While it would not be impossible to achieve, it would take several months more to finalise the primary legislation, followed by the preparation of statutory instruments. In my view, this would entail putting in place a cumbersome legal and administrative infrastructure to deal with what is only a temporary first phase on the way to universal GP service to the entire population.

The Cabinet committee on health has discussed the issues relating to the delay in the initial step of the roll-out of the universal GP service. In doing so, it has considered the importance of weighing the balance between, on the one hand, resolving the legal issues but with a further delay and, on the other, the need to bring forward an important programme for Government commitment with the minimum of further delay.

Additional information not given on the floor of the House

No decision has been taken by the Cabinet committee or by Government on changing the first step of the plan to extend GP care without fees to persons with chronic illnesses. Instead, it has been agreed that we should prepare and set out a number of alternative options with regard to the phased implementation of a universal GP service without fees. The Minister, Deputy Reilly, and I expect to report back to the Cabinet committee in the near future. As part of this work, consideration will be given to the approaches, timing and financial implications of the phased implementation this universal health service.

The Government has already made clear its commitment to delivering on the implementation of a GP service for the entire population by providing additional financial resources in the two most recent budgets. The HSE Vote now contains funding of €30 million for this year for an initial phase of the provision of GP services as part of this programme for Government commitment. Far from abandoning its commitment to universal GP care, this Government is determined to expedite the implementation of a national GP service for the entire population, something to which no previous Government has ever aspired.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Will the Minister of State spell out exactly what alleged legal issues have arisen with regard to the promised extension of free general practitioner care to people on the long-term illness scheme? He indicated this could only be done over a protracted period. His words will offer little solace to those on the long-term illness scheme who are coping with serious health issues. They were expecting free general practitioner care to be extended to them on the basis of a commitment to do so set out in the programme for Government. This commitment was to be the first element in the roll-out of the plan to introduce free GP care for all. What exactly are the legal difficulties to which the Minister of State referred? Will he indicate for what other purpose the €17 million allocated for the first phase of the roll-out will be used?

Alex White (Dublin South, Labour)
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The funding allocated for the measure was not €17 million, but €15 million last year and a further €15 million this year. As such, the HSE Vote contains funding of €30 million for this year for an initial phase of the provision of general practitioner services as part of the programme for Government commitment.

I touched on the legal issues in my initial response. I have never stated in the House during any of the discussions on this matter that the legal issues that have arisen were insurmountable. I have stated, however, that addressing these complex legal issues would require more time and result in the establishment of a complex and cumbersome bureaucratic structure for only one phase of what will be a large project. It would not make sense to do so much additional work to put in place an infrastructure or legal framework that would only deal with the allocation of medical cards on the basis of a medical condition. While the legal issues are not insurmountable, having reviewed the entire project, it has been decided that it would not make sense to go down that road.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It does not make sense that it has taken a couple of years to make that determination. The Minister of State's argument is absolute nonsense and offers cold comfort to those who are dependent on the long-term illness scheme. He has added to their difficulties in life by dashing their expectations.

The Minister of State indicated he will present an alternative plan within a matter of weeks. I ask him to spell out exactly what he proposes to do. Given that phase one of the planned roll-out of free GP care has been abandoned, what is the position regarding the second phase, which was to extend free GP care to those on the high tech drug scheme? What message does the Minister of State have for the cohort of people who depend on the scheme? Where stands the promised new general practitioner contract?

Alex White (Dublin South, Labour)
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I know I do not have much time.

Peter Mathews (Dublin South, Fine Gael)
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The Minister of State has one minute to reply.

Alex White (Dublin South, Labour)
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With respect to Deputy Ó Caoláin, it is a pity he will not address the issue we are dealing with.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister of State should answer the questions. I had only one damn minute to put them.

Alex White (Dublin South, Labour)
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From what I can see, the Deputy may need to take some chill pills. Let us try to be serious about a serious proposal. It will have been clear to anyone listening that going down the route envisaged would entail further delay. I will be straight with the Deputy: the delay is regrettable. We are now putting serious shape on something that looked like it would cause more delay. We are taking it into a-----

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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What is the position regarding phase two of the Government's commitment? Will free GP care be extended to people on the high tech drug scheme?

Alex White (Dublin South, Labour)
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Deputy Ó Caoláin's problem is that he does not like to be given an answer. He goes on about seeking an answer and then complains when one is provided. I will not be able to tell the House-----

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister of State is blathering.

Alex White (Dublin South, Labour)
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That is rich coming from the Deputy. If he wishes to talk about blather, he had better look closer to home.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister of State is filibustering and failing to provide the information I seek.

Alex White (Dublin South, Labour)
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The plan will be presented to the Government before the summer. That is the commitment and it will be met. I will be delighted to hear what the Deputy has to say at that stage.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Minister of State provides a mighty crutch for his senior Minister.