Seán Kyne (Fine Gael) | Oireachtas source

I welcome the Minister to the Chamber. I congratulate him on his role and wish him the best. I welcome the opportunity to contribute on this Bill, which will achieve two objectives, the first of which is the expansion of GP care without charge to children and young people. The Bill contains provisions to extend and expand this important benefit to children under eight years of age, under ten years of age and under 13 years of age on a phased basis. Second, the Bill will fulfil an important budget commitment to increase the weekly income limit for older people when applying for a medical card from €500 to €550 for a single person and from €900 to €1,050 for a couple. Both commitments were agreed by the previous Government and the decision to continue with them is welcome. The Bill is an important next step in the introduction of universal GP care, which is a recommendation of the all-party Sláintecare report.

The briefing notes that I have been provided by officials describe the health system as providing for two categories of eligibility - full eligibility, that being, medical card holders, and limited eligibility, that being, all others. The description in the Oireachtas Library and Research Service's paper on the Bill that says there are two categories - those with a medical card and those without one - is more appropriate. Every Oireachtas Member and councillor has spent time on healthcare issues, including medical card and GP visit card applications for constituents. Each of us has experienced cases where a person or family has been refused one card or the other despite experiencing genuine and evident difficulties. One goes around the houses trying to get information and letters from doctors and consultants, which are sometimes just one-liners and not appropriate in terms of expressing what the patient or family needs. These are important issues for people. As colleagues have stated, additional benefits derive from the medical card, or the miracle card as some people have called it.

We all should know that early intervention in medical problems is essential. It is next only to the pursuit of a healthy lifestyle. The real challenge for us as legislators and for wider society is deciding how to ensure the provision of timely and appropriate healthcare as and when it is needed. We made progress in recent years under Fine Gael-led Governments. This should be recognised. Free GP care was provided to children under six years of age, to all older people aged 70 years and over and to all children with disabilities and their carers.

Free GP care helps to ensure that children, older people and those with disabilities can access healthcare so as to achieve the best outcomes. Furthermore, it reduces pressure and worry on parents and guardians as well as older people on fixed incomes. However, we cannot ignore the serious challenges facing us. These include the cost of free GP care and the capacity of the GP system. There seem to be different views in the House.That may be geographical. It may be based on people's real experiences. While some people may say genuinely they do not feel there are capacity problems in their constituency, town or locality, other people may say there are genuine problems.

The Department of Public Expenditure and Reform last year indicated that the expansion of free GP care to all children under the age of 13 would cost €50 million per year, which is not much in the context of some of the moneys that have been spent recently. In addition, the increase in income limits for medical card assessments for people aged 70 or older would cost an additional €30 million per annum. From the additional funding needed for these two measures, the substantial additional investment that will be needed to introduce universal GP care becomes clear. That is obviously where we want to be able to move to, but the move has to be incremental because the costs are somewhat prohibitive if large leaps are taken on eligibility.

The primary care reimbursement service, through which medical cards, GP visit cards and other GP services are fulfilled, was allocated €2.9 billion in budget 2020, a substantial portion of the health budget. The budget for primary care was €1.08 billion. We need to continue to direct more funding to primary care on the basis that it improves overall outcomes and represents the most sensible expenditure of public money.

The second major challenge is capacity, as I have said. While the number of people training to become GPs has increased in recent years, which is very welcome and encouraging, the general GP workforce is getting older, with retirements impacting the level of service, particularly in rural areas. Our population is increasing and our people are, thankfully, living longer. However, these facts place additional pressure on GP services across the country. Moreover, the policy decisions, welcome as they are, to increase free GP care invariably increase the number of people visiting GPs, although, again, I have heard different opinions on that here. That is certainly what has been relayed to me in my area.

Finally, the out-of-hours services provided by GPs are also very important and are under pressure. Westdoc in Galway is an excellent service but is under severe pressure in areas such as Moycullen and Oughterard, for example. Local doctors work on a rota basis to provide out-of-hours cover but they are doing so more frequently and more regularly. Westdoc needs additional resources to allow it to expand, something I raised with the Minister's predecessor and which perhaps the Minister may be able to influence over the coming year.