John Minihan (Progressive Democrats)

I am delighted to speak on this motion and I welcome the Tánaiste's appointment to the health portfolio. While the health service is one of the major issues of debate, we should remember that our health service, when compared internationally, is a very good one. I admit there are problems but since 1997 the coalition Government has endeavoured to address these in many ways. Various reports on health reform have been compiled and are now in their implementation phases. The Progressive Democrats, along with our Government partners, are confident that when we face the electorate, it will be seen that we have delivered on the commitments made to health service reform. Members have argued that if the reform of the health service were purely a question of money, we would have a health service second to none. Members should recall that €10 billion is now spent on health care compared to €3 billion in 1997. If we had known then that €10 billion would be spent by 2004, our health service would now be second to none. However, this is not just about money.

The medical card system can be looked at as a glass half full or half empty. It must be acknowledged that many people's standard of living has increased to such a point that they can forfeit their entitlement to a medical card. That is not to say there will not be people on the threshold who find themselves ineligible. The introduction of the minimum wage should be used as a benchmark for society. If one is below the minimum wage, one should be ineligible for taxation and entitled to those services provided by the State such as medical cards. Hopefully, this will be achieved some day.

Any examination of the medical card system must be done in the wider context of the operation of the GMS scheme. Between 1997 and 2003, the scheme's budget increased from €303 million to €938 million. Much of this additional investment was required due to increases in drug costs, the demands from a growing population and an increase in the number of general practitioners operating in the scheme from 1,600 to approximately 2,200.

The Government introduced medical card eligibility for those over 70 years as an assurance that they can, without fear of financial restraint, approach doctors for medical care. Approximately 1.15 million people are covered by medical cards. While I admit this is a lower figure than previous years, it can be explained by our changed economic circumstances. Many people are no longer eligible on means grounds. The management of the medical card scheme and the introduction of databases have removed duplicate and deceased card holders. These improved internal management structures within the health boards in identifying those eligible for medical cards have changed the figures. The introduction of the co-op scheme with general practitioners providing 24 hour direct access to a doctor has also made a difference. Further work is needed to alleviate the difficulty of people going directly to accident and emergency departments rather than their GP for minor medical issues. This has created a bottleneck at one end while at the other, sufficient step-down facilities are not available to free up acute beds. With the implementation of the reform programmes adopted by the Government, more people opting for co-op GPs and step-down facilities, the freeing up of acute beds will increase. The Government has responded to the need for reform with increased staffing for general practitioners — for example, nurses, whether asthma specialists or general GP nurses, can now work in GP surgeries. Given our multicultural society, GPs are being offered training to deal with non-EU nationals and language difficulties. Funding has been put in place by this Government in that regard.

I have no doubt the Government is committed to extending medical card coverage, as set out in the health strategy, to increase the number of persons on low incomes eligible for medical cards and to give priority to families with children, in particular children with a disability. While this commitment may not have been met to date, this Government will be judged on what it delivers over a five year timeframe. History has proven that if we continue to pump money into the health service without addressing the management deficiencies in that service, we are throwing money at a system which will not deliver the standard of health care we want.

The health boards and their chief executive officers have addressed the new guidelines laid down for the extension of medical card facilities for those returning to full employment. That was a welcome development in that people were not dissuaded from entering the workforce on the grounds that they would lose their right to a medical card. These are welcome measures which are necessary in order to move people away from becoming dependent on a social welfare system and to encourage them to go back into the workforce.

I support the Government's amendment. We have a health service that is moving in the right direction and we now have a Minister who will continue the reform programmes this Government has set out. When the Government completes its term of office, it will be seen to have made a major difference to the health service delivered to all citizens.