Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

Before I speak on the Bill, I wish to say what a great honour it is to be here in the Seanad. I am sorry that we are all moonlighting in the Dáil Chamber but I am very much looking forward to stepping into the hallowed grounds of Ireland's Upper House at some point. It is a huge honour and privilege to hold the office and to be here with Senators today to debate this Bill. Thank you for your good wishes, a Leas-Chathaoirligh. There is quite the task ahead in healthcare in the Covid world.

It is my pleasure to introduce the Health (General Practitioner Service and Alteration of Criteria for Eligibility) Bill 2020 to Seanad Éireann. I believe it is our obligation as elected representatives to look after those who need it most and I am therefore very pleased that this Bill provides for two key measures that will positively impact children and people over the age of 70.

First, the Bill provides for a welcome increase to the gross income limits for medical card eligibility for persons aged 70 or older and, second, for a phased expansion of GP care without charges to all children aged 12 and under. Sláintecare provides a necessary and long-awaited process for reorienting our health system from one that treats only sick people to one that keeps people well. That is why the measures provided for by this Bill are so important. They will enable us to take another important step forward towards achieving the health system the people of Ireland need and deserve.

A range of measures has already been implemented to expand access to people in receipt of medical cards and GP visit cards. This includes the provision of medical cards to people in receipt of domiciliary care allowance, which was done in 2017, the provision of GP visit cards to people in receipt of a carer's allowance and carer’s benefit, in 2018, and in 2019 the increase in the GP visit card income thresholds. All of this has resulted in 43% of the population now having access to GP care without fees. However, while these initiatives are very welcome, this Government recognises the need to do more. That is why we have committed in the programme for Government to implement new measures to expand access to GP care without fees and to wider health services. As Minister for Health I am delighted to be bringing forward this legislation for debate here today, and affording it the priority that it deserves. The first key measure in the Bill is a welcome increase to the gross income limits for medical card eligibility for people aged 70 or older. Everyone should have the opportunity to live a long and healthy life, and we all know the world is ageing and we are living longer. Increased longevity is a welcome indication of improved public health and social and economic development here in Ireland and in many other countries around the world. As many individuals age, however, they will face the risk of having at least one chronic disease, such as hypertension or diabetes, and we must ensure our health system is designed to meet the consequences of these continued and evolving demographic changes.

The World Health Organization defines healthy ageing as "the process of developing and maintaining the functional ability that enables well-being in older age". Functional ability is about having the capabilities that enable all people to be and do what they have reason to value. This includes a person's ability to access basic needs like healthcare. Currently, 75% of people over 70 hold a medical card. Having regard to the prevalence and co-morbidity of chronic diseases in the population of people over 70 and the benefits to be achieved through improved health and well-being, I wish to ensure, therefore, a greater proportion is afforded access to health services at a time when health needs are higher.

I should also highlight that this is the first increase in the income limits since they were reduced in 2014. Today's Bill therefore provides a very welcome increase. If the forecasted numbers of people to benefit from this measure materialise, it will result in approximately 87% of the population who are over 70 having medical card coverage. The income limits we will discuss are an increase of approximately 10%, although we will get into the detail. This increase of 10% could see coverage extended to half the number of people who still do not have access to a medical card. The benefit is beyond what we might think if we just looked at the increase in limits.

I now turn to the second key measure provided by the Bill, which is the phased expansion of free GP care to primary school children. Senators will be aware that our programme for Government also includes a commitment to expanding access to GP care without charges to more children. It is an important deliverable for the Sláintecare implementation strategy, which commits to expanding eligibility for access to healthcare on a phased basis. Since 2015, all children under six have been eligible to access general GP services without charges, along with periodic health assessments and the asthma cycle of care programme. This has been a very successful measure, with more than 250,000 children under six eligible to access GP care without fees. The most recent Healthy Ireland Survey indicates four in every five children under six had attended a GP in the previous year, which really demonstrates the welcome benefit of increasing access to affordable healthcare, or in this case healthcare free at the point of use. We must still pay for the service.

There is a clear rationale and obvious benefits to expanding universal access to GP care to children. It will bring important lifetime benefits both for our children and society as a whole, ensuring early intervention and healthy behaviour from a young age, as well as reducing long-term healthcare needs and the associated costs that come with this. Furthermore, evidence points to the importance of introducing policies to promote health and well-being and tackle inequalities in health, as they are likely to be more successful the younger the age groups targeted. The earlier and more quickly we can get to children, the better off they will be for the rest of their lives.

We also know the cost of GP visits acts as a barrier to accessing care. The Growing Up in Ireland study, for example, indicates that those who face out-of-pocket expenses to access GP care make significantly fewer GP visits, and that children from higher income families are more likely to visit the GP than children from lower income families. The measure being debated today will ensure therefore, that irrespective of the social and economic background of the children and how much money their parents earn, every child up to the age of 12 will have equal access to GP services without charge. It is a significant milestone and I am proud to welcome this beneficial public health measure.As well as removing a potentially prohibitive cost barrier to accessing healthcare, the continued provision of the additional services already available to children under six, such as the asthma cycle of care, will help to improve children's health and well-being as they develop through middle childhood. Moreover, this progressive measure will also ensure continuity of care for children in the under-sixes cohort. This will now deliver a full continuum of care from birth right to the age of 12 provided by the GP. It is why I want to extend access to GP care without charges to more children.

Today's Bill provides a legislative framework to continue on this path of universal expansion. Already, nearly 200,000 children between ages six and 12 have access to a GP without charges either through the medical card scheme or other schemes. It is estimated that expanding GP care without charges to children up to the age of 12 will benefit an additional 300,000 children in our society, which would be fantastic. However, I recognise a move to a universal access system for health coverage is challenging.

The timing of implementation requires very careful consideration and the initial stage of the phased expansion will therefore be to all children aged six and seven, so as not to overwhelm the health system and general practice, which as we all know is struggling with capacity now. Specifically, the legislative framework in the Bill provides a roadmap for expansion. Phase 1 will be for children aged six and seven; phase 2 will be for children aged eight and nine; and phase 3 will be for children aged ten, 11 and 12.

GPs have been the first port of call for patients in the Covid-19 context and they deserve major recognition for the work they have done under extraordinarily difficult circumstances, so it is imperative that general practice continues to be in a position to provide healthcare to all patients in a sustainable manner. In that regard and taking account of the forthcoming winter in the context of Covid-19, it is crucial an expansion of GP care does not inhibit general practice from delivering ongoing care in the community for all patients. The implementation date for the expansion will therefore require careful consideration by officials in my Department and the HSE, as well as input from the Houses. That said, I firmly believe it is important to bring forward the legislation today as it provides the legal framework to enable expansion to be progressed and implemented when the timing is right.

The purpose of the Bill is therefore twofold. It will provide the legislative framework for the further phased expansion of GP care and to increase the gross income limits for medical card eligibility for persons aged 70 and older. Before I outline the main provisions of the Bill I note a miscellaneous provision in the Bill, which is an amendment to the 1970 Health Act to take account of the new governance structures in the HSE. Essentially, it is about switching the terms "director general" and "chief executive".

The main provision provisions are as follows. Section 2 amends the existing legislation relating to gross income limits for medical card eligibility for persons aged 70 or older under the 1970 Health Act. The amendment to section 45A of the Health Act 1970 provides for an increase in the gross medical card limits for persons aged 70 or older to €550 per week for a single person, where it is currently €500 per week, and to €1,050 per week for a couple, where it is currently €900 per week.

Section 3 provides a technical amendment to section 53C of the Health Act 1970 to replace the reference to "director general" of the Health Service Executive, HSE, with "chief executive officer" of the HSE. This necessary technical amendment ensures section 53C of the Health Act 1970 is consistent with the Health Service Executive (Governance) Act 2019, which amends the references to the director general of the HSE and replaces them with references to the chief executive officer of the HSE.

Section 4 amends the legislation under the Health Act 1970 that relates to the making available of a general practitioner medical and surgical service, or the GP card, without charges to persons who are ordinarily resident in the State under six years of age. The amendment of section 58 and 58B of the Health Act 1970 expands the availability of this service to persons ordinarily resident in the State and who have not attained the age of eight years. This is the first age category being provided with eligibility for free GP care under the phased system. This is a complicated way of indicating that children aged six and seven will become eligible for the scheme.Sections 5 and 6 provide for making general practitioner medical and surgical services available without charges to persons who are ordinarily resident in the State and have not attained the age of ten years and 13 years, respectively. These are the second and third age categories being provided with eligibility for free GP care under the remaining two phases of expansion. In other words, section 5 is for eight and nine year olds and section 6 relates to those aged ten, 11 and 12. Section 7 provides for the Short Title to the Bill and for the introduction of both GP expansion and an increase in the medical card gross income thresholds by commencement order, as required, with the consent of the Minister for Public Expenditure and Reform.

I am personally pleased to bring this progressive measure forward and to debate it in the Seanad today. I am confident the Bill will bring about real change in our health service. More importantly, it will bring about real change for patients and members of the public who need access to care and who might not be getting the full access they require at present because of the cost. This will make a significant difference. I am sure many Members of the House have been contacted by people over the age of 70 years, the one in four who do not have the medical card, asking them when this change will be introduced. It will make a difference to them and it will make a world of difference to worried parents who were previously unable to afford to bring their children to the GP. I commend the Bill to the House and look forward to hearing the views of Senators.