David Cullinane (Sinn Fein) | Oireachtas source

I welcome the Minister of State, Deputy White. This is a Bill to implement the Government's commitment to provide GP care to all children under the age of six years. Like Senator Crown, I want to see universal primary care for all citizens that is free at the point of delivery. I will not oppose the Bill. Senator Crown made the point that the Bill needs to be the start of a transparent roll-out of free GP care for all over a particular timeframe. Otherwise, it will only further emphasise the inequalities in our health system.

The context of the debate is the Government's U-turn on discretionary medical cards. We were told by Ministers in the months leading up to the recent local and European elections that there was no such thing as a discretionary medical card. It was something the Taoiseach repeated over and over when he was questioned about the issue during Leaders' Questions in the Dáil. We are now being told that 15,000 discretionary medical cards have been removed from people since 2011, and these will be returned. These cards should not have been removed in the first place. We in Sinn Féin said so, as did others, but the appeals fell on deaf ears. We also appealed to the Government in a motion in advance of the elections on 23 May to restore them, and I am sure the Minister of State was one of those who voted against the Bill at the time. It was only after the elections - in which both parties, but particularly the Minister's party, got a good kicking - that there was a wake-up call and the soul-searching that Senator Crown spoke about, and the U-turn followed.

The Government's decision leaves many unanswered questions. It leaves out many people who have been refused medical cards. We are told that some 15,300 people who have lost their medical cards since 2011 will receive notices by letter in the next few weeks that their medical cards will be reinstated. This is confined to former holders of medical cards on a discretionary basis related to hardship caused by particular illnesses, conditions or disabilities. Of course that is fair, and we would support that. Those concerned submitted documentation to the HSE when they were notified that their cards were being reviewed. There is a huge discrepancy between the number of people in the above category and the number of cards that have been removed, which is 30,000. I have no doubt that many people who had their discretionary medical cards taken from them looked at the situation and decided there was no point in proceeding with a review process because what they could see at the time was a roller-coaster of culling and cutting. As they did not proceed with the review process, where will they stand? Are people who validly held medical cards but did not proceed with the review process to be excluded from consideration? Will there be a process of appeal or review for those who had their cards removed over the relevant period but do not receive a letter in the coming weeks? Will there be an opportunity for them to apply again? What about those who applied for cards on discretionary grounds over the relevant period and had their applications refused? Given that the same criteria of assessment were applied to such people between 2011 and 2014, surely they are equally entitled to have their situations taken into account?

I will now address the Health (General Practitioner Services) Bill 2014. People understandably ask where is the fairness in giving free GP access to a healthy child of four while denying it to a very ill or disabled brother or sister who happens to be more than six years old. Where is the fairness in giving free GP care to a disabled child from birth and taking it away from him or her on reaching the age of six? These are the anomalies and inequities that are built into a system that is not based on true universality of access, which should be based on medical need alone, regardless of income or age. The Government will argue that it cannot roll out universal free GP access in one go.

I believe that is fair enough and it is a valid response. As we support the principle of universality, we will not, of course, oppose this Bill. We are prepared to regard it as a first step and take the Minister's word that this is what it is.

My concerns are very similar to those of Senator Crown. Where is the timeframe and the programme to roll out universal free GP care in a progressive and transparent manner? It is most certainly not in this Bill. We are being asked to take a very big leap of faith where we are not getting the details of any timeframe in regard to how this will be rolled out. The Bill lacks clarity in that area and it certainly lacks a timetable for the rollout of universal free GP care for all, to which I know, with respect, the Minister of State is personally committed.

We also need to take into account the concerns of GPs regarding the under-resourcing of primary care. They have stated that their workload has increased while resources have been cut. While I would obviously argue with the Minister about medical cards which have been cut, the people who have lost their medical cards and so on, we all accept there are more medical cards out there. The reason for this is that people have lost their jobs or are on low pay, and they are entitled to medical cards based on income grounds. At the same time, however, the resources to GPs have been cut by €160 million. The Government spends just 2% on general practice out of the total health expenditure, both public and private, compared to 9% in the North and in Britain, and practices are struggling both financially and in terms of capacity, as a number of other Senators pointed out. We have to listen to the concerns of GPs and make sure they are properly resourced and can roll out free GP care for all when the time comes. While we will meet with resistance from some, I would hope the majority will see this as progressive and as something that should be embraced and delivered. The test of that will be how this is rolled out and accepted.

As a first step, the Bill is to be welcomed. It is something that is hopefully the start of a process that will lead to universal free GP care for all and a serious investment in primary care. Huge strides have been made in recent times in primary care centres and in far more integrated care at primary care level. It is the way to go, it is revolutionary, it is delivering best practice health care and it is something I am very much supportive of. The more we invest in primary health care, the better it will be for all and the less pressure we will end up having on our acute services.