Derek McDowell (Labour)

I think the Minister of State has more of a sense of humour than the Senator. However, I wish the Minister well.

The specific purpose of the motion this evening was to deal with the issue of medical cards. I want to make a political point first which needs to be said. There is a notion abroad that the two parties in Government made a large number of promises before the last general election and have systematically broken them all since. That is not actually fair to the Government. The Government parties did not make many promises before the general election. They made relatively few that would catch the eye. This was one of perhaps two or three that was important and caught the eye, deceived people and persuaded them to vote for the Government. It was an important undertaking and promise on behalf of the Government parties. That in a sense emphasises the level of betrayal people feel and the hypocrisy in which the Government has engaged. It is regrettable.

Speakers on the Government side such as Senator Minihan said they could not rush into this, being only seven years in Government. They could not be expected to deliver on such a promise which was given only two or three years ago. Others said so much money had been spent without any immediate results being expected. They need to look for value for money, reform of the system and so on. All of this is fair in itself, but does not address the net issue the House is discussing this evening, namely, medical cards.

I want to talk about GP services in particular, and to some extent pharmaceuticals, and everything that follows from that. This is a net issue which can be disposed of with relative ease provided there is the political will to do it and to engage with the medical profession, GPs and their representative bodies to ensure we have a system that is capable of delivering.

The former Minister for Health and Children, Deputy Martin, told the Dáil only a few months ago that it would cost about €685 million to introduce a comprehensive GP system. The figure for extending medical cards to all those under 18 would be just €151 million. I do not mean this personally but when I listen to Members on the other side of the House such as Senator Feeney suggesting that the medical card might, perhaps, be extended to tiny cohorts such as children under four, I wonder at our lack of ambition in this country. It would cost €151 million to extend the medical card system to all those under 18. We are spending multiples of that on far more frivolous purposes. The wonderful SSIA scheme is costing €600 million a year. For a quarter of that cost the medical card could be extended to all those under 18.

I am sure the Minister is well aware that there is a particular difficulty with children. These are the people, unfortunately, who are most likely to suffer owing to the lack of a comprehensive system. All of us have met mothers who have to make difficult choices between keeping the household moving in a particular week and bringing a child or children to the GP. It is an unfortunate fact that those who are least likely to be able to afford the €35 to €50 for a visit to a GP are the people most likely to need the service. They are young children and people in poorer households with lower incomes. These are the people most likely to need GP intervention because of malnourishment, poverty and its effects and, perhaps, unemployment. Unfortunately, these are the people who can least afford it.

My party believes and argues passionately for a comprehensive GP system and free access to family doctors. Such a system is taken for granted in most western European countries. What is crucially important is that we can afford it. All that is required is agreement from the general practitioners in order to introduce the system. I do not underestimate this. I imagine the Government will extend eligibility over the next few months. It will be looking at a number of different ways to do it. It could be extended on an income basis by, for example, widening the threshold for means tests. It could be done on the basis of infirmity involving people with particular illnesses who must see a doctor on a regular basis. It could also be achieved by targeting a particular age cohort.

If the aim is to end up with a system in five or ten years where everybody has access, then I do not suppose it matters which particular half-way house is used. I would favour doing away with the means test in favour of an age cohort of those under 18. However, that should be done only if the intention is to end up with a comprehensive system that facilitates everybody. If it is not, then a more complex mix is needed. We need to ensure in the first instance that people who visit the doctor on a regular basis are not prevented from doing so. We must also ensure that people on low incomes are not prevented from going to the doctor by virtue of that fact. A more complex reaction is needed, therefore, if the Government intends to do it on a bit by bit basis.

I know, however, that the Minister is one for big ideas and likes to take large strides. I would urge her to look at the possibility of a comprehensive arrangement and deal with the doctors on the basis of a per capita system, a per item mechanism or some combination of the two. Frankly, I do not care but whatever system we put in place should facilitate people through its ease of access.

I want to mention the primary care strategy. All of us are persuaded that this is the way forward and that investment in primary care is essential not just for itself, but because it takes the emphasis off secondary care, which is far too common in this country. We depend far too much on secondary care intervention at far too early a stage. All of us are persuaded of this fact.

The previous Minister for Health and Children, Deputy Martin, was quite persuasive in his convictions and the manner in which he put forward the case. I have heard the current Minister refer to this briefly over the past couple of weeks. It is essential we do not lose track of this. Much of this is not sexy, but it is of major importance. There are only ten primary care teams in the country, despite all the trumpeting three years ago. They are acknowledged to be generally successful where they have been introduced, but ten teams after three years is a pitiful result. We need to be moving forward. I believe general practitioners are more open to these radical moves than they might have been ten or 15 years ago. We know that members of the medical profession, GPs included, wanted for many years to ensure that their private patient base was effectively protected and resisted so-called socialised medicine because of that concern. The profession is changing, not least because there are now far more women doctors who want a life and who are quite happy to work eight or ten hours a day.

I am also conscious of the fact that there are many women, and indeed men, in the medical profession who are anxious to change the way GPs work and do not want to be on call 24 hours a day, seven days a week. They want to have a life and to do a decent job. They are more than anxious to get into serious negotiations with the Minister and her Department. I hope she is also anxious to do so. If so, she will have support from this side of the House.