Alex White (Dublin South, Labour) | Oireachtas source

Senator Gilroy welcomed the Bill. He said, correctly, that it was a first step. Along with Senator Crown and Senator Cullinane, he asked whether any thought had been given to the next steps. I will come to that in a moment. The point was made about GPs and the importance of meaningful engagement. That is certainly going to happen, absolutely.

Senator Barrett made a point about there being no reference to cost. This proposal has, in fact, been costed. A sum of €37 million was set aside in last year's Estimate. Therefore, there is a costing. Senator Barrett may wish to maintain opposition to it for the reasons he gave, but it would be wrong to say it has not been costed. Respectfully, I disagree with Senator Barrett on the notion that the management or funding of the health service or decisions about the distribution of resources in the health service constitute interference - that was the word he used - with doctors. Doctors are entitled to a high level of professional autonomy; there is no question about that. They are the experts in their field. However, we are the Parliament. We should determine the proper distribution of resources and people's entitlements or eligibility. We could do so in line with what Senator Barrett advocates or in line with what I advocate, but either way, we are the people who make the laws. Of course doctors are entitled to be consulted, but we as the Legislature make the decisions about the distribution and allocation of resources.

Senator Noone made a point about the importance of engaging with doctors. I agree with what she said. I have covered the points on the nominal charge and the contribution of GPs.

Senator Darragh O'Brien can rest assured that we will we keep the House updated with the progress in returning cards awarded on a discretionary basis. The Senator may have these figures already but, as of 27 June, a total of 4,151 cards have been returned. As he rightly said, the process is continuing. He has observed it in his area and I agree that the process is continuing. Anyway, we will give a further update as soon as it becomes available.

I take Senator O'Brien's point about the review process and questions that are repeated even where information may be available on the system. This has occurred in circumstances where a person's medical condition is unlikely to change, where it is relevant to his application and where he has expenses associated with it. It should be possible - I understand it is now possible - for the HSE not to repeatedly ask questions that have already been asked and settled in a particular application. The Senator is right about that.

The Government's approach to GPs must be fair. I have made that point. We have a framework agreement and we are proceeding on that basis. There are live issues in the discussions and negotiations, such as the gagging clause and the five-year contract limit, and these will be addressed. I accept that many doctors have legacy costs and investments and so forth, and I understand the environment we are dealing with in the case of many GPs. They have explained this to me and I accept it.

Senator Crown made a point about the hospital system being dysfunctional, although he said he supported the legislation. The notion that we were taking cards from one group to give to another was put forward. I have never accepted that this was what was intended, although I accept that this is the way it was represented. I believe this very good proposal was discredited or that people sought to discredit it in circumstances in which people were pointing to mistakes and decisions that had been made elsewhere. Naturally enough, in public discourse people set one off against the other. Anyway, that was never the intention and it is not the intention. Senator van Turnhout made the point that it is not about taking from one and giving to another; it is about trying to expand or introduce a proper system.

I was the person who was quoted as saying there is no such thing as a discretionary medical card but I was merely trying to say that all medical cards are the same. If people make an application for a medical card they go through the means test system first. If they do not succeed in that, they can then invoke the discretionary element. I was trying to make the point that a medical card is a medical card, irrespective of how one got it but, again, it was interpreted as me trying to say there was no such thing as discretionary medical cards. It may have been picked up wrongly and I regret that people may have received it in a dismissive way from me. It was never intended in that regard.

I agree with Senator Cullinane. We are trying to reform the system we have, and I accept that anomalies and contradictions are being exposed in the course of that. If we go for a cut-off point of six years of age there will always be the question, "What about the seven year old?" However, I question the argument about giving the card to children under the age of six whose parents are wealthy and so on. We have a primary school system where we do not charge the children of millionaires, TDs or Senators to send their children to primary school. Another Senator made the point that there are many low and middle-income earners who cannot get a medical card. The argument about the children of millionaires is nonsensical but to the extent that we are talking about the children of millionaires, we have ways of dealing with social equity, whether it is through the taxation system or otherwise, that we can all debate on another occasion but the universal system should be in place just as much in the area of health services as it is in the area of education where I support it. Those arguments are weak but they arise from the contradictions that will inevitable emerge from only providing it for young people up to the age of six when we would love to do it for everybody in one fell swoop, and we cannot.