Marc MacSharry (Fianna Fail) | Oireachtas source

I welcome the Minister. I wish him luck later this week in terms of the personal political deliberations.

I welcome this Bill. While there was much discourse over the last number of months about the Bill, I and my colleagues had a serious problem with it against the backdrop of the medical cards debacle. It is a noble cause to try to engage in early intervention, which this Bill will achieve, in terms of creating the necessary engagement with the health service from the earliest stage, so we all have histories, and in terms of trying to help families who are to the pin of their collars. Those aims are noble and we certainly support them.

The medical cards debacle was highly regrettable. We had a taste of it ourselves when we were in government in respect of the over-70s. However, it went on for some time and that is regrettable.

In fairness, the Minister of State has acknowledged that it is regrettable that Members on all sides in both Houses have been obliged to place on record the anecdotal evidence being made available to them in their clinics. Members have been outlining the distress being caused to families, individuals, children with Down's syndrome, those with serious illnesses, etc., for some time. However, it took a major political development, namely, the loss of hundreds of local authority seats by various parties in the recent elections, before someone decided it was time to take action. My general criticism of the political process is that in many ways we live in a dictatorship disguised as a democracy. A couple of people run the whole show. It is a closed shop with one or two senior civil servants involved. Those who run the show ignore, as a matter of form, their own backbenchers and the Parliament as a whole. I have often stated that the Parliament is actually subservient to the Government of the day. It should be the case that the Cabinet of the day - regardless of its political hue - should be subservient and responsible to the Parliament. In practice and regardless of who is in power, this sadly does not happen. We all face a challenge in this regard going forward.

We are within the so-called three-week period when 15,000 or so discretionary medical cards and GP visit cards are due to be returned. I have seen some evidence that they are being returned, which is a hugely welcome development. I hope all of those affected will have their cards returned to them as quickly as possible, because that is what is required. That said, the Bill before us is to be welcomed. I do not doubt the Minister of State's personal commitment but I am not so sure the Government has gone about what it is doing in the correct manner. In essence, it made an announcement, is proceeding with its work and is only now knuckling down to what might prove to be difficult negotiations with the IMO. I welcome the conclusion of the framework agreement. As with Europe and the United States, the authorities here had no one to speak to on behalf of GPs. Thankfully, some progress is now being made in this regard. In the context of any adjustment of competition law, Fianna Fáil is committed to allow for the appropriate consultations to take place on a collective basis.

We must exercise caution during the negotiation phase. We can all criticise various aspects of the health service. I refer not to the individuals who work within it but rather to its general management and organisation. One area in respect of which I believe we can all pretty much agree the health service is working well is the provision of primary care by GPs. We must be cognisant of the need to avoid, if possible, messing up in this area.

It is easy for politicians and members of the public to state that consultants make a fortune. While a salary of €109,000 or more per year seems huge to me, I am conscious of serious competition from abroad. I read a newspaper article in recent days which stated that consultants in Ireland are among the highest paid in the world. I am not so sure, particularly when one considers that 250 posts throughout the country are vacant and there is no queue of people seeking to fill them. I am not trying to focus too much on money, but we are not attracting the relevant people. It appears that young doctors who have completed their GP training are attracted to Canada and Australia. I do not know whether it is actually the case, but it seems that annual salaries of €250,000 are on offer, pretty much the norm and achievable in these locations. If it is a choice between entering a new set-up and flogging their bodies for a salary in order to try to build up a list of clients, and travelling abroad to available of opportunities such as these, then I can understand the attraction.

From a consultant's perspective, one can understand why people might leave the country if it is a case of earning hundreds of thousands per year as opposed to €109,000. I met a retired orthopaedic surgeon who originally trained in Canada. He informed me that good interns and senior registrars worth their salt who are seeking to become consultants are worth between $700,000 and $900,000 per year. I consider that amount of money to be obscene, but if that is what we are up against, then we have a problem. We will be obliged to devise some innovative ways of dealing with the disparity that exists in this regard and in respect of GPs. We must certainly be cognisant of the disparity in salaries in the context of the overall aspiration of having free GP care for everybody. If we have an expectation that people who have studied for 11 years or more are going to provide their services for what I might consider to be either the average industrial wage or an appropriate wage, we are going to be disappointed.

The principles behind what the Government is doing are all fine and the benefits are many. However, there is a need for it to be extremely careful in the negotiation phase and in what it might seek to do in upsetting what is generally a good system. We all agree with the aspiration to make the system better but we must ensure that we get it right. In the current climate, it is difficult to approve of the payment of large amounts of money. However, we must not throw the baby out with the bathwater.

I hope no one will interpret what I am about to say as being racist. We are extremely lucky that people of other nationalities are prepared to come here to work. I understand that 15 years ago the number of non-consultant hospital doctors from abroad working here stood at 5%. That figure is now heading in the direction of 25%. There are a number of factors at play in this regard. It is great to have those doctors here, but we must ask whether we are exporting expertise on one hand and then importing it on the other. Is that an appropriate way to proceed? I recall Senator Crown explaining on a previous occasion that all 20 senior oncologists in this country had trained at the top six institutes in the United States. There is not a hospital or state in the US that would not give anything to have that type of expertise available to it. Will we be able to say the same thing 20 years from now, or will we have exported our best and brightest?

I would appreciated it if the Minister of State would take the couple of points I have made on board. There are issues we may raise on Committee Stage, but we will be supporting the legislation.

The services available at accident and emergency departments can be abused on occasion. When free GP care for those under six years of age becomes available, we must appeal to the public to be responsible when it comes to the use of the service. There cannot be a scenario in which a person with a headache goes to the accident and emergency unit; he or she must go to his or her GP. Some private health insurance companies offer a system whereby they have nurses on call and their customers can ring them to seek medical advice. When one has one's first child, every time he or she belches one wants to know what is going on. Perhaps a similar telephone service might be provided in respect of those under six years of age in order that their parents might obtain advice as to whether they need to bring their child to see a GP or whether they should proceed directly to accident and emergency. It might be useful to consider introducing such a service.

The Minister of State has my best wishes in the contest due to take place later in the week. I am conscious of the fact that he began his political career in this House and it would be great to have a party leader with whom I shared these benches.

I commend the Bill to the House.