Sean Barrett (Independent) | Oireachtas source

I move amendment No. 1:

In page 9, lines 47 and 48, to delete all words from and including "Insofar" in line 47 down to and including "Executive," in line 48.

Cuirim fáilte roimh an Aire Stáit ar ais go dtí an Teach. I propose in the amendment to delete, "Insofar as it is considered practicable by the Health Service Executive,".

It should be noted from this amendment that I am not seeking, in this subsection, the deletion of the following: "a choice of medical practitioner shall be offered under the general practitioner medical and surgical service made available under this section." This is a commitment that the House made, as the Minister acknowledged in debate yesterday, as a response to the IMF programme to open up the general medical service to new medical entrants. Yesterday I put on the record some numbers of persons earning ¤700,000 plus. We wanted to get new graduates, many of whom had to emigrate, to be allowed to practice as GPs. That was earlier recommended by the Competition Authority. It is the express wish of this House, in legislation, that such is what we wanted.

There is an absolute requirement that the Minister allows new graduates to take up their places. The Health (Provision of General Practitioner Services) Act 2012 opens up access to GMS contracts to all fully qualified and vocationally trained GPs, and there will be no limits on the number of contractors. Section 2 of that Act provides that the Health Service Executive will be entitled to enter into a GMS contract with any suitably qualified and vocationally trained general practitioner and will not be limited to granting contracts in cases where a GMS contract holder has died, retired or resigned or where the contract has otherwise been terminated. Section 5 of that Act, most importantly, provides that the HSE, when filling or creating a GP position, will not take account of the short-term or long-term economic viability of that or of other GP practices.

Why has this provision been included? These obligations are to be met in so far "as it is considered practicable by the Health Service Executive". While I have much less experience of the House than the Minister of State, Ministers have not stated in my time in the House that the Revenue Commissioners will collect tax, the Garda Commissioner will investigate crime or the Minister for Education and Skills will provide primary school places in so far as it is considered practicable to do so. The Health Service Executive was given obligations by the House as part of the agreement with the International Monetary Fund. A service must be provided from the wide range of new graduates, rather than by those on salaries of ¤700,000 per annum. I am not interested in whether the HSE considers this practicable or not as it has a duty that was imposed on it by Parliament.

We referred to legacy issues yesterday. Senator Crown's Bill on smoking disappeared into the Department and has not been heard of since. Similarly, his Bill on the practice of uninsured medicine has also disappeared. The Department lost a case on health insurance in the Supreme Court by a unanimous decision of the court and lost a case on the same issue in the European Court of Justice. I do not trust it when it states a choice of doctor will be available "insofar as it is considered practicable". This is the law and the Department must adhere to it. The Department has a record of showing disregard for the wishes of Parliament. This is a legacy issue rather than one that has arisen in the Minister of State's time in office.

I do not know the reason this provision has been included in the Bill as I have never seen another Minister invoke a similar provision. We decided, and it is internationally agreed, that there will be a general practitioner service with a choice of doctor. This is not at the discretion of the Health Service Executive or any official. I am worried generally about the extent to which officials dictate to the Government. Elected Members made a commitment in the House and it would not cost much to meet it, particularly when compared to the ¤700,000 or more we pay to certain general practitioners. I do not know why this subsection is in the Bill.

I supported the Government's position on the new income arrangements. Why should we seek to renege on a commitment by using the weasel words "insofar as it is considered practicable"? The HSE does not have a great record. Parliament should determine these matters and I hope the Minister of State will agree to remove the section. This is an obligation incurred as part of an international agreement and attempts to change it in this section come from a Department that does not have the happiest of relationships with the House. It is time the House asserted itself.