Alex White (Dublin South, Labour) | Oireachtas source

I thank all of the Senators for their extremely insightful contributions on this Bill. I interpret the general thrust of what has been said, with perhaps one exception, as support for the Bill, although not unqualified support. I have very much taken note of, including physically in my notebook, the various comments and observations that speakers have made. I find myself in much agreement with almost everything that has been said by those who have welcomed the Bill, although not in an unqualified way, particularly given the context of the recent controversy about medical cards awarded on the basis of discretion and the decisions that were required to be made in that regard. I understand what Senators are saying and also the context in which they have welcomed the Bill. On a personal note, I thank all of the Senators who wished me well in another matter in which I have been preoccupied to some extent in recent weeks.

Senator MacSharry made the point at the outset of his speech that early intervention in health and well-being, and the importance of promoting and enhancing primary care, is what he termed a "noble cause". If I may say so, Senator MacSharry very much gets it in terms of what this is about. This is about putting in place a system of primary care, free at the point of access, which is consistent with all of the international literature and research in regard to health services.

While I do not want to come directly to what Senator Barrett said, it occurs to me that all of the international literature, experience and insight suggests we should have a robust system of primary care that does not have the barrier of fees in respect of access. There is very substantial evidence that fees are a very real barrier even for people who are relatively well off. This is about the health needs and the well-being of the population, and it is not just about access for people of low means, although I do not want to underplay that. The question is how best to configure the health services. All of the international evidence is that the best way, and I would venture to say the only way, for us to even begin to hope to reform the dysfunctional system Senator Crown talks about is to put in place a primary care system that works, is properly funded and does not rely on the kind of market-driven approach that has characterised a good proportion of the health service.

I do not believe the necessity to pay a fee should ever be a barrier for anybody attending a doctor. That is well established in practically every other country in the OECD, certainly in the European Union. We are a complete outlier with regard to the demands we make on so many people to pay fees to attend their general practitioner. I believe very strongly that we must address this now. There will never be a good time to do it, certainly not when coming out of a catastrophic economic collapse. If one had a chance to pick a period in history to reform the health service, reorient it towards primary care and introduce free GP care, one would probably not pick the current period. This is where we are, however, and we have to start from where we are.

Senator MacSharry made a point about negotiations and said he was not sure we were going about this in the right way. I take him to refer to the consultations and negotiations with GPs. I have always made the point that it is critical we have a meaningful engagement with the representatives of general practitioners - I have made that point from the outset and it remains my view. The negotiation and agreement of a framework agreement, signed at the beginning of this month, is the basis for that to now happen. The GPs, the IMO in particular, have very real, understandable and legitimate concerns about the obstacles that were there or appeared to be there in respect of the meaningful engagement they need to have with the State in order for them to be sure they get paid a proper fee for doing what they are doing, that there is a contract that is fit for purpose and that they have an input into the content of that contract.

Senator Noone made the point, and I agree, that doctors are crucial to this and their confidence in this is hugely important. The framework agreement facilitates that. It did take a number of months to put together and we did have a period in which there was a stand-off, which was unfortunate. Nonetheless, I attended and addressed the IMO annual conference, and engaged with the members there. It was a very good engagement, although it was not always the friendliest or the easiest for doctors in circumstances where they felt something was being imposed on them. However, we got through it. We talked through the issues, we engaged together and we then managed to get this process going, which I call talks about talks. This was literally to get a framework agreement in place that can actually be the basis for us moving ahead. Substantive discussions, not just talks about talks, have now commenced in regard to this matter. I will say no more than that they have commenced, I hope they will proceed and I have every confidence that they will.

Senators MacSharry and Noone both raised an issue regarding young GPs and the pull to leave the country and go abroad. These are very real workforce planning issues but they are also very real issues for the individual doctors themselves, men and women who are trained in this country and would like to see themselves working in this country, raising families and having a good and fulfilling professional life. I want to see that as well. A report from Professor Brian MacCraith is beginning to address these issues and has been brought forward by him to the Minister for Health. It is a very real issue. I am sorry Senator MacSharry is not still present, although I am sure he is busy.