Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I thank everyone who made a contribution to the debate. It is such a small Bill that it is difficult to take it apart and analyse it. I have always listened to and respected what Senator John Crown has to say as anyone who works within the system must be listened to, but in my view this is an incredible step in relation to the circumstances of the country. I am not talking about the economic circumstances now, but about where we find ourselves and the type of access we have had to primary care in the main in the past. Once one has a means-tested system, one will always have someone who is just outside of it. There is always the hard case in that scenario. We would love to be able to introduce a system of universality right across the population but we cannot, unfortunately, afford that right now.

There are issues around the principles attached to this. As Senator Bradford rightly points out, we do not ask people to pay for the education of their children no matter what their income is. We take it as a given. It is a benefit to the country that people are educated and, therefore, we find that investment is good for both the population and the country. Good health is equally important and as beneficial to the country as a whole as it is to the individual, which is hugely important. This is a significant step. For the first time ever, we are rolling out universality to a particular block of people and that will progress. The promise in the programme for Government is that it will extend to 12 year olds, which is what Senator Gilroy asked about. That is to say children of primary school age will be covered and then it will progress to 18 year olds. There is no commitment beyond that. However, it is hoped it will move on to a different cohort under the next Government, which, again it is hoped, will be composed of the parties to the current Administration. I hope it will move to the group of people who are the wealth producers and who should be the healthiest within the community. That is a significant step forward. Other countries looking in at us will probably say: "What is the big deal? We have always had this." That simply indicates how far behind we have been in terms of how we have provided access to health care to people.

I note to Senator Crown that, thankfully, this is one of the few areas for which I do not have direct responsibility even though I have a huge interest in what happens in our accident and emergency units and acute hospitals. I hope the changes we are making in primary care will have an impact on the acute hospitals. They should. Another programme we are about to roll out very shortly is the minor surgeries programme for which we have earmarked 20 sites nationally. At these, minor surgery will be carried out in the GP surgery setting. That should have an impact on our accident and emergency units and attendance at our acute hospitals. The building up of the primary care sector should relieve the pressure on our acute hospitals. I will not say here and now that it will, nor will Senator Crown, as we cannot be certain. However, I cannot think of any other way to do it other than to ensure people who have a difficulty with their health go to the most appropriate place. That is rarely an accident and emergency unit, which should be reserved for exactly what is indicated in the protocol.

The asthma checks are simply for the under-six cohort. We already have dedicated specialist nurses in place in certain primary care settings. I note to Senator Thomas Byrne that, as we all know, asthma is about control and management and we hope this will benefit children into the future. As such, this will naturally continue along in the process of the roll-out of the medical card to under-12s and under-18s. I am hopeful about that.

I heard recently on "Morning Ireland" something that comes up time and again, which is that we are giving medical cards to the children of wealthy people while sick children are not getting it. The number of discretionary medical cards has increased since January 2015 from 50,000 to more than 80,000. It is a better and more sensible and sensitive way of doing things. Any child in those circumstances who makes the right case to the PCRS will get a very good hearing. The discretionary element of the scheme is how it should be handled as no one wants to see a family with a child in distress having to go through the trauma of trying to get the services they need. That is one way of dealing with it.

I have already noted that we are rolling out minor surgery at 20 sites nationally. If the project is seen to work, we will roll it out further. All of these things coming together should provide greater access to primary care at local level. At the end of the day, the last place most people want to be is in hospital unless there is no other alternative. We all want to be treated near our own homes and in the most appropriate setting possible.

I commend the Bill to the House. It is a good piece of work for the country and while it is a fulfilled promise and commitment of the Government, every politician should be able to take pride in it. It is something we will look back on and ask why we did not do this sooner.