John Gilroy (Labour) | Oireachtas source

I welcome the Minister to the Chamber. I welcome the Bill as the legislative basis for a new universal GP service. I point out that €37 million has been provided in the 2014 budget to fund this initiative, which is a funding provision over and above that which already exists within the system. To say the funding is being diverted from existing services is not just factually incorrect but politically dishonest. I have heard the argument used all too frequently and, I am afraid, all too effectively during the recent elections. When the legislation is implemented, 240,000 children who must currently pay to see a GP will have access to free GP care. Almost half the population will have access to free GP care, which is the first step in the provision of free GP care to the entire population. This is also a key step towards the provision of universal health insurance. I ask the Minister what the next step is.

It has been asked why high earners who can well afford to provide for their own children's GP care should be included in this. This is the argument about universality versus means testing. When one puts a means test in place, one must decide where to set the threshold. It comes back to what Senator van Turnhout spoke about and the question of whether we go down the utilitarian route of the greatest good for the greatest number or the rights-based route. My preference and that of the Government is for a rights-based approach to health service provision.

I attended several meetings of GPs in the south of Ireland over the last number of months. The GPs outlined vocally their concerns and spoke not so much about the provision of free GP care for the under-sixes, but in general terms about the new GP contract, which was drawn up under a previous Minister. Whoever drew up the contract certainly gave GPs plenty of scope for concern. Certainly, they made well-targeted criticisms of it. The situation has not been helped by the fact that it was thought that the ruling of the Competition Authority precluded GPs' representatives from entering into strategic negotiations with the Minister and the Department. The Minister referred to the June agreement with the IMO and he might say a few more words on that in his response to the debate.

Our ability to deliver a universal health insurance system has been questioned by many commentators in politics and the media. It has been said that it cannot be done at all, that nothing has happened and that the political will is not there. The Netherlands has a system which is something like the one we are purporting to introduce here. It took almost 20 years to introduce it there. The Dutch model is based on numerous health care providers and insurers competing for resources and it appears to offer best value for money and the best health outcomes. There is high patient involvement, which is key, as well as very low political interference. The latter is very important and something we could perhaps do with in this country. One of the main criticisms of the system involves its cost. Studies have shown that a high level of expenditure does not always equate with good health outcomes. What is more important than the amount of money spent on health services is the organisation and political culture in which health or any other services are being delivered. That is the best guarantor of good health outcomes. In preparing for the debate, I was amused to read one report which referred to politicians involving themselves in the provision of health care as well-meaning amateurs who ultimately undermine the very system they purport to support. We have a bit to learn in this country in that regard.

At one of the meetings I attended in the south with GPs, a politician who shall remain nameless stood up and said he had received 26 representations on health issues that very day. That struck me as more than most GPs in the room had received. There must be something very wrong with a system where people feel the first port of call for health care delivery is a politician rather than a medic. The diagnosis not the remedy is the awful two-tier system we have. There is competition for resources and access to health is not always determined by medical need but often by one's ability to pay. I am glad to support the Minister's efforts to reform health services radically and get rid of the awful two-tier system the results of which we see in our clinics all the time. I am glad the legislation is before us today and that the first step is being taken in the radical transformation - not simply reform - of the health service. I look forward to continuing to support the Minister's efforts.