Billy Kelleher (Cork North Central, Fianna Fail)
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74. To ask the Minister for Health the timeframe for the delivery of the primary care commitments in the Programme for Government; and if he will make a statement on the matter. [30751/13]

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. This is the first Government in the history of this State to commit itself to implementing a universal GP service for the entire population.

It has become 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. Relatively complex primary legislation would be required to provide a GP service to a person on the basis of him or her having a particular illness. The assessment system for such an approach would have to be robust, objective and auditable 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, and who could do this, and how to select the diagnostic basis for medical conditions. There would also be a need for secondary legislation to give full effect to this approach for each condition. While it would not be impossible to achieve this, it would take several months more to finalise the primary legislation, followed then by the preparation of statutory instruments. 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.

However, the Government is firmly committed to introducing a universal service within this term. The Cabinet committee on health has discussed the issues relating to the roll-out of the universal GP service. In doing so, it has considered the delay in the initial step and 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.

It has been agreed that a number of alternative options should be set out with regard to the phased implementation of a universal GP service without fees. The Minister and I have updated the Taoiseach on this matter and we expect to report back to the Cabinet committee in the near future. As part of this work, consideration is being given to the approaches, timing and financial implications of the phased implementation of this universal health service.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Government's credibility on this issue has been shattered. The programme for Government states, "Access to primary care without fees will be extended in the first year to claimants of free drugs under the long-term illness scheme at a cost of €17 million". We are in year three and there has been no roll-out of free GP care for long-term illness claimants nor has there been any form of expansion. We are no wiser about the Government position on the need for primary or secondary legislation or as to what will happen to ensure the programme for Government commitment is honoured during its term. The Minister of State said the Cabinet has been apprised of the issue and a decision will be made in the near future. Five weeks ago, we were told it would take six weeks for the Minister to come back with proposals on the best way forward to address this issue. The cost to the Exchequer of the full roll-out of this service will be €500 million in year five of the Government's term but the Minister of State could not even secure the €17 million required to cover long-term illness claimants. The senior Minister snaffled that last year. What is the position on the long-term illness commitment and the commitment to roll-out primary care in the programme for Government?

Alex White (Dublin South, Labour)
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The Deputy referred to credibility. Not only did the Government of which he was a supporter and a member not get around to extending universal GP care but it had a policy opposing it. It is extraordinary for him to raise the credibility of this Government in those circumstances, given the policy position of the previous Government in opposition to universal health care. He will be wiser within weeks. We told the House that we will come forward with our alternative workable and achievable proposals in this regard by the summer. We are on course to do that and the Minister and I have discussed the issue as late as this week. We are having intensive work done. I have been engaged in intensive work on this in recent weeks. I have worked harder on this issue than any other in the Department to put together a set of proposals with their delivery times outlined, which is something we have not witnessed from any Government in the history of the State in the context of universal GP care, given its importance in the management of chronic illness and across the board. Money will be available and the Government has made clear its commitment to delivering on the implementation of this service. The HSE Vote contains funding of €30 million for this year for the initial phase of the provision of the service. The Government will deliver, as distinct from fail to deliver, on this fundamental element of health policy of the party opposite.

Billy Kelleher (Cork North Central, Fianna Fail)
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I never questioned the Minister of State's commitment but his delivery of this proposal is at stake here.

The difficulty is that while we are discussing these grand plans, letters are being circulated to people throughout the country, some in their 70s and 80s, by the primary care reimbursement service requesting a review of their medical card entitlement. I have raised this issue time and again, including with the Taoiseach. A constituent came to me in recent days whose wife has undergone a double mastectomy but who, because the household income is just above the threshold, will not retain her medical card.

Alex White (Dublin South, Labour)
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People who are entitled to a medical card will retain it. The Deputy is misleading the House.

Billy Kelleher (Cork North Central, Fianna Fail)
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I certainly am not. I have raised this issue on many occasions. The case I mentioned is just one example of the circumstances in which people throughout the country now find themselves, as every Member of this House will attest. While we are discussing the Government's grand plan for primary care provision, people are being terrorised because they have been randomly selected by a computer system to have their eligibility for a medical card reviewed.

Alex White (Dublin South, Labour)
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The Deputy is being irresponsible in the language he is using.

Billy Kelleher (Cork North Central, Fianna Fail)
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Some 40,000 people have already been selected for review, as far as I can ascertain. The grand plan has been announced but the day-to-day reality is that medical cards are being withdrawn and people who would previously have qualified on discretionary grounds are no longer being accommodated. That is the truth of the matter.

Alex White (Dublin South, Labour)
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The Deputy should not use words like "terrorise" in this context. An additional 100,000 medical cards are being issued this year, although I accept that 40,000 have been reduced to GP-only cards. Additional cards are being issued all the time by the Health Service Executive.

Billy Kelleher (Cork North Central, Fianna Fail)
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Not on a discretionary basis.

Alex White (Dublin South, Labour)
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To be clear, any person who is entitled to a medical card will retain it. I absolutely support the HSE's efforts to ascertain people's continued entitlement to a medical card. This will ensure that the huge resources necessary to maintain the medical card system will be used in the best way, for the benefit of those who are genuinely entitled to it. That is what the Government is about, and I expected to secure the Deputy's support in this regard.

Billy Kelleher (Cork North Central, Fianna Fail)
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Discretion has been withdrawn.

Kathleen Lynch (Cork North Central, Labour)
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That is not true.