Billy Kelleher (Cork North Central, Fianna Fail)
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57. To ask the Minister for Health why the undertakings on universal health insurance and the introduction of free general practitioner care for the whole population, the two key health commitments in the 2011 programme for Government, were not honoured; and if he will make a statement on the matter. [4093/16]

Billy Kelleher (Cork North Central, Fianna Fail)
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If the Taoiseach comes to the Dáil, I will be happy to give way to him at any stage during my question. I want to ask the Minister for Health why the undertakings on universal health insurance and the introduction of the free GP scheme for the whole population, which were the two central planks of the Government's policy in 2011, have not been fulfilled? The Minister has abandoned universal health insurance and it now appears he has abandoned the roll-out of free GP care to the whole population. Will he explain why those two key policies were not implemented?

Leo Varadkar (Dublin West, Fine Gael)
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The Government has embarked on a multi-annual programme of health reform, the aim of which is to deliver universal health care, as defined by the World Health Organization, where everyone can access the health services they need, which are of sufficient quality to be effective, while ensuring that the use of these services does not expose them to financial hardship.

In April 2014, the White Paper on Universal Health Insurance was published. Following its publication, the Department of Health initiated a major costing project, involving the ESRI, the Health Insurance Authority and others to examine the cost implications of a change to the particular UHI model proposed in the White Paper. The reports detailing the estimated cost of this UHI model were published on 18 November 2015. Having considered the findings, I concluded that the high costs associated with the White Paper model of UHI are not affordable and that further research and cost modelling on the best means to achieve universal health care was needed.

The next phase of research will include deeper analysis of the key issue of unmet need and a more detailed comparative analysis of the relative costs and benefits of alternative funding models. This work will be carried out under the auspices of the joint Department of Health-ESRI three-year research programme on health reform. Both the research undertaken to date and that planned in the next phase of the costing exercise will assist the next Government in its decisions on the best long-term approach to achieving the shared goal of universal health care.

I should add that when I assumed the office of Minister for Health, I concluded that while progress had and was being made on health reform, the original timeline for implementation of universal health insurance, UHI, was too ambitious. I also emphasised my commitment to progressing health reform and my determination to push ahead with four key building blocks, namely, the Healthy Ireland strategy and the public health agenda; building sufficient capacity to satisfy unmet demand; the expansion and development of primary and social care; and reforming structures, information and communications technology and financial systems with key initiatives, such as the phased extension of GP care without fees, the establishment of hospital groups and community health organisations, the implementation of activity-based funding and the improved management of chronic diseases. These all are major milestones on the road to universal health care and have the potential to drive performance improvement and deliver significant benefits in terms of timely access to high-quality care.

Additional information not given on the floor of the House

Already GP care without fees has been successfully introduced for children under the age of six years and all people aged 70 years and over. This has resulted in approximately 800,000 people now being eligible for GP care without fees and without being obliged to undergo a means test. The under-sixes service includes age-based preventive checks focused on health and well-being and the prevention of disease including asthma and diabetes. In budget 2016, the Government made financial provision for the extension of GP care without fees to all children aged six to 11 years. It is envisaged this third phase will bring the total number of those eligible for universal GP care without the obligation to be assessed by a means test to approximately 1.2 million people. The progress made in recent years in introducing universal health care, together with the improvement in public finances, provides a very good basis upon which to plan the next phase of improvement in our health services.

Billy Kelleher (Cork North Central, Fianna Fail)
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A cursory glance at the programme for Government and an analysis of it with the benefit of five years of hindsight shows it is a catalogue of failure. The two central tenets of health care delivery in Ireland were to be universal health insurance and free GP care for everybody. There has been an abandonment of the universal health insurance model as was outlined. It appears to have been parked, even though there is a pretence it is not off the agenda. However, the bottom line is the Government has failed to implement any part of universal health insurance. If one moves on to universal GP access, the Minister announced last night he also was delaying or potentially abandoning it because of the lack of capacity in the GP services. In this Dáil Chamber, Fianna Fáil Members repeatedly and consistently raised the need to enhance the capacity of GP services before any roll-out of universality and were consistently ridiculed as being opposed to it. However, they were not opposing but were merely highlighting the inadequacies of preparation in bringing about of universal access to GP services. Such services are not akin to buses in Calcutta, in that one cannot just keep putting things in and expect it to keep filling, as at some stage, something will give. The reason so many people are on hospital trolleys across Ireland, day in day out, is because GP services cannot cope.

Leo Varadkar (Dublin West, Fine Gael)
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I do not accept the analysis that people are on hospital trolleys because GP services cannot cope.

Billy Kelleher (Cork North Central, Fianna Fail)
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It is a fact.

Leo Varadkar (Dublin West, Fine Gael)
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That may be true for a small number of patients on trolleys but generally speaking, it is the case that if somebody is on a trolley waiting for a hospital bed, that person is there because he or she has been seen by a doctor, or perhaps by two or three doctors, and those doctors have determined the person requires admission to a hospital. Consequently, the idea there is somehow a direct correlation between GP services and patients on trolleys is incorrect.

I appreciate the Government's term of office is almost at an end and the Dáil will be dissolved this week. The Deputy's question has two parts and the programme of Government will cease to exist as a live document this week. As for proposals being put forward by different parties for the general election, different parties of course will put forward different proposals. The proposal of my party is to extend GP care without fees to everyone under 18, as well as to provide for chronic disease management care for adults with common chronic diseases such as diabetes, asthma, chronic obstructive pulmonary disease, COPD, heart failure and other things like that.

Leo Varadkar (Dublin West, Fine Gael)
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I believe that is all achievable and affordable in the lifetime of the next Government.

Billy Kelleher (Cork North Central, Fianna Fail)
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Everybody accepts that primary care is the way to address the challenges being faced in the delivery of health care. The Minister himself has consistently stated that if it is possible to increase the capacity of the primary care system or to enhance the ability to deal with chronic disease and chronic illness, it will have an impact on overcrowding in the emergency departments. The point I make is that while there is overcrowding at present in GP practices nationwide, they are incapable of dealing with complex issues. They are under huge time pressure and if one contemplates ensuring that people are dealt with in the area of least complexity, that is, in the GP services or at home, one must increase primary care capacity. However, the Government has singularly failed to do this. All the Government has consistently stated was it intended to roll out universal GP access to everybody. This has not happened and in the meantime, there has been an undermining of the capacity of GP services nationwide to deliver health care in the primary care setting.

All in all, as this Dáil comes to an end, the Minister must accept the Government's health policy has been a disaster from start to finish. Every benchmark or index on which the Government wishes to adjudicate its success or failure shows it has singularly failed in every area.

Leo Varadkar (Dublin West, Fine Gael)
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Better primary care and better social care are part of the solution to the problems in our hospitals. It is not the entire solution. The Deputy must bear in mind that if more people are seen in a primary care setting, that may result in more referrals to hospitals. On one level, more people will be managed in the community but, on another, more illness will be picked up. If we have much better primary care in Ireland, for example, doctors will start diagnosing the 50,000 to 100,000 undiagnosed diabetics in the community and even if only 10% of them have to be referred to hospital clinics, that will mean an additional 10,000 attendances. There are interplay factors and people often over-simplify this too much. There is evidence, although it is less than convincing, that GP care without fees for those under six years of age has resulted in an increase in referrals to paediatric emergency departments. I would like to see a full season's data before being convinced of that because other factors could be at play, not least the respiratory syncytial virus.

We have learned a great deal from those under six years of age and those over 70 years of age. It has been a great success but we are learning from it. There has been an increase in attendances by those under six years of age at GP services and there has been a significant increase in attendances at out-of-hours services. We have to factor all that into future planning. It will be necessary to increase the number of GPs over time and, therefore, we need to ensure there is not a mismatch between the increase in the number of GPs and trainees and what we ask them to do. That is why my party is putting forward proposals that we believe are ambitious but achievable in a five-year period. I am disappointed that the Deputy's party proposes to stop at six years of age and not extend the scheme further. That is a real shame.