Alex White (Dublin South, Labour) | Oireachtas source

It is my pleasure to introduce the Bill, which will provide for a general practitioner, GP, service to be made available without fees to all children aged five years and younger. The key features of the Bill are as follows: it provides an entitlement for all children aged five years and younger to a GP service without fees; it removes the need for children aged five years and younger to have a medical card or a GP visit card under the general medical services, GMS, in order to qualify for a GP service; it will remove the need for many families with children aged five years and younger to be forced into a situation where they need to consider whether the child is sick enough to justify paying for a visit to the GP; it provides that the HSE may enter a contract with GPs for the provision of this GP service to children; and it provides that the Minister may set the rates of fees payable to GPs for this service.

The Government is committed to introducing, on a phased basis, a universal GP service without fees for the entire population. At present, just over 40% of the population can access a publicly-funded GP service. The balance of the population, almost 2.5 million people, must pay the market rate for a GP consultation, which is currently in the region of €55 per visit.

A number of consequences arise from this. It deters some necessary medical care because it is generally recognised as unreasonable to expect an individual to make a good decision on what is necessary and unnecessary care. Given the complexity of health issues and modern health treatments, an individual does not have the expertise to make a fully informed decision. That is why the ability to attend a GP is so important as a gateway to accessing care in the health system. The current situation also works against the objective of increasing and enhancing the role of primary care and preventive care. It is difficult for a person to justify spending money today on a GP visit for an issue that may or may not become serious at some point in the future. Finally, the current situation impedes the reorientation of our health system from a hospital focus to a primary and community care focus, which is an objective we all share. When this first phase is in place, approximately one half of the population will be covered by a GP service without fees at the point of use.

As announced in the budget, the Government has decided to commence the roll-out of a universal GP service for the entire population by providing all children under the age of six years with access to a GP service. It is important to be clear that nothing will change for families who currently have, or are eligible for, medical cards, including those with children under the age of six. They will continue to receive all of their medical card entitlements as normal. There will be no change for them. They will not be affected in any way.

The 2013 report of the expert advisory group on the early years strategy recommended providing access to GP care without fees to all children in this age group. There are good reasons to provide universal access to GP care in view of the health needs of the cohort aged under six years. The identification of health issues at an earlier age can mitigate or reduce the impact of ill-health later in life. For example, the Growing Up in Ireland survey reported that almost one in four children in Ireland are either overweight or obese, which is likely to lead to significant health issues later in life.

We must move towards a health system based on universality of access, which must be sustainably funded to enable the provision of services to meet health needs.

It is important that we view this Bill as a stepping stone to universal GP service. I wish to see the rapid roll-out in successive phases of more GP coverage, and I would not be as supportive of this legislation if the under-sixes scheme were an end in itself. This Bill is a stepping stone. It is the first phase, not an end in itself. If we believe, as I do, that our society should progress to a universal GP service, I ask Senators to support this Bill as the first step towards achieving a universal service.

The policy objective is to have the entire population covered by a State-funded GP service. A universal GP service is a vital building block of universal health insurance and the reform and restructuring of our health service. A universal GP service will also complement the existing universal hospital system. The Government's clear aim is to achieve this objective by 2016.

I now turn to the substantive provisions of the Bill. The primary purpose of the Bill is to provide for a general practitioner service to be made available without fees to all children aged five years and younger. The Bill provides that the HSE shall make available a general practitioner service without fees to all such children. It also provides that the HSE will be entitled to enter into a contract with any suitably qualified and vocationally trained general practitioner for the provision of GP services to all children aged five years and younger, and the contract will specify the services to be provided by the GP. The Minister for Health may, by regulations and with the consent of the Minister for Public Expenditure and Reform, fix the rates of fees and allowances to be paid to GPs for services provided under these contracts.

Section 2 amends the existing legislation relating to appeals under the Health Act 1970. It provides for the extension of the current HSE appeals process to decisions on the operation of the new GP service for all children aged five years and younger and also for the director general of the HSE to appoint persons to carry out appeals. It clarifies that where the person carrying out an appeal is an employee of the HSE, that person shall hold a grade senior to the original decision maker. The existing provision in the Act that the Minister may make regulations in respect of the appeals process is restated without change.

Section 3 amends the existing "ordinarily resident" framework in the Health Act 1970 to reflect changes made in section 2. It also extends the "ordinarily resident" framework to include the new GP service for all children aged five years and under.

Section 4 removes children who have not yet attained the age of six years from the existing GP service under the medical card scheme as provided for in section 58 of the Health Act 1970. They will be covered by the new service under section 58B. As I mentioned earlier, it is important to be clear that nothing will change for families who currently have, or are eligible for, medical cards, including those with children under the age of six. They will continue to receive all of their medical card entitlements as normal.

Section 5 is the heart of the Bill. It provides for the insertion of sections 58B and 58C into the Health Act 1970. Section 58B provides that the HSE shall make available a general practitioner service without fees to all children aged five years and younger. It provides that a parent or guardian of a child seeking access to this service should provide to the HSE such evidence as it considers necessary to demonstrate entitlement to the service and where such evidence is not provided the HSE may treat the child as if he or she is not entitled to the service. Where possible, the HSE will offer a choice of GP to those accessing this service.

Section 58C provides that the HSE will be entitled to enter into a contract with any suitably qualified and vocationally trained general practitioner for the provision of GP services to all children aged five years and younger. However, the HSE may enter into a contract for relevant services with any registered medical practitioner who already holds a GMS contract for the six month period following commencement of the section. The contract shall specify the services to be provided by the GP.

In addition, the Minister for Health may by regulation, and with the consent of the Minister for Public Expenditure and Reform, fix the rates of fees and allowances to be paid to GPs for services provided under these contracts. The section requires that the Minister, in making a regulation for this purpose, shall engage in consultation. Further, it prescribes the role of the Minister and the HSE, the nature and manner of the consultations and the considerations to which the Minister must have regard in making regulations, including having regard to agreements entered into with the representatives of GPs relating to the conduct of such consultations.

Senators may be aware of the framework agreement with the Irish Medical Organisation, IMO, which I signed on 4 June. This agreement sets out a process of engagement on all aspects of the GMS contract with GPs, with due regard to the IMO's representative role and within the context of legislation underpinning the introduction of GP care free at the point of access. That engagement with the IMO has begun with regard to the draft contract for the provision of services to all children aged five and younger. Under the framework agreement, the IMO can fully represent its members in respect of discussions around all aspects of this draft contract, including fees, and in respect of the GMS contract. Where the rates fixed by regulation under this section are varied under subsequent regulations, a GP who does not wish to continue providing services may terminate his or her contract by giving the HSE three months notice.

Section 6 is a technical amendment to the nursing homes support scheme to put beyond doubt that assets which are transferred after an application for the scheme is made also come within the definition of "transferred assets". The purpose of the amendment is to prevent a situation arising where an applicant could transfer assets immediately after an application for State support is made on the basis of an argument that such asset transfer is not definitively captured by the definition of transferred assets in Schedule 1 of the 2009 Act. The nursing homes support scheme is predicated on the principle that applicants must contribute according to their means. The existing Act provides that assets transferred within the five years prior to applying for the scheme are taken into account in the financial assessment. The provision does not affect a person's right to sell assets for full market value. Rather, it is intended to prevent people from depriving themselves of assets for the purposes of the financial assessment. If a participant in the scheme were to transfer assets immediately after an application for State support is made, or at any point subsequent to that, the existing definition means that it may be possible that the asset could be excluded from a financial review. Therefore, it is essential that there is no ambiguity in this regard, and this amendment seeks to address that.

Section 7 is a technical amendment that will change the election year for the Opticians Board from 2014 to 2015 and provide that the subsequent election years will be 2019 and each fifth successive year after 2019. The purpose of this amendment is to have the practical effect of removing the requirement to hold elections to the Opticians Board this year, a matter of months before the board is due to be subsumed into the Health and Social Care Professionals Council. This is in accordance with the Government's programme of rationalisation of State agencies. The drafting of the Bill to rationalise the Opticians Board into the council is currently being finalised,. It is intended that the regulation of the professions of optometrist and dispensing optician will be transferred to the amended Health and Social Care Professionals Act 2005 by the end of this year or early next year.

Section 8 is a necessary technical amendment to enable the seamless implementation of section 2. It extends the existing eligibility appeals process to the new GP service for all children aged five years and younger.

Section 9 states the Short Title of the Act, provides for the collective citation of this and prior health Acts as the Health Acts 1947 to 2014 and includes a standard provision relating to commencement of the provisions of the Bill.

In conclusion, the main purpose of the Health (General Practitioner Service) Bill 2014 is to amend the Health Act 1970 to provide for a general practitioner service to be made available without fees to all children aged five years and younger. I look forward to hearing the views of Senators and I hope that they and people in general will support this landmark first step to universal GP service for the entire population of the State.

I commend the Bill to the House.