Health (General Practitioner Service) Bill 2014: From the Seanad

The Dáil went into Committee to consider amendments from the Seanad.
Seanad amendment No. 1:
Section 6: In page 7, between lines 10 and 11, to insert the following:
"6. To amend section 58C of the Act of 1970 by inserting the following new subsection:
"(13) Notwithstanding any other part of this section, the agreement, referred to in subsection (1) shall not:
(a) include any provision to restrict the criticism of the Health Service Executive, or the Department of Health;

I do not intend to object to the Seanad's amendment. However, I do wish to clarify a number of points for the record.

I am sympathetic to the intent and purpose of the Seanad amendment, as proposed by Senator Crown and adopted by the other House. It would not be appropriate to restrict criticism, to impose obligations to limit criticism, to require a GP to notify or to get prior approval from the HSE in advance of saying something, or in any way to dilute the natural right to freedom of expression implicit in the Constitution.

However, it is important to be clear that there were no such restrictions in the draft contract. The specific clause in the draft GP contract which prompted this amendment stated that the service provider, that is, the GP, shall not do anything to prejudice the name or reputation of the Health Service Executive. This is not an unusual clause in a service contract. The draft clause 28.4.4 was not in any sense intended to impose unwarranted or inappropriate restrictions on individual GPs in advocating on behalf of their patients.

Deputies will be aware that the Department of Health and the HSE are currently in substantive discussions with the Irish Medical Organisation, IMO, on the draft contract for the provision of GP services to all children aged five and younger. At a recent meeting, the Department and the HSE confirmed to the IMO that this clause will not be included in the final contract.

There was never any intention by the Department or the Health Service Executive to gag GPs. This clarification to the Irish Medical Organisation has removed any doubt on the matter.

While I will not object to the amendment, its exact wording may give rise to some concerns. The effect of the amendment on any obligations on GPs as to confidentiality or privacy may need to be considered in the future. The language is unusual. Indeed, the reference to the implicit recognition of the right to freedom of expression in Article 40.3.1° of the Constitution is peculiar, as the same right is explicitly guaranteed, subject to public order and morality, by Article 40.6.1°.

On a general point, I acknowledge the widespread support in principle for this Bill, both in this House and in the Seanad. Members quite legitimately made their alternative views known and raised their concerns during the debates on this legislation. I also acknowledge the significant work that went into advancing this legislation by the former Minister for Health, now Minister for Children and Youth Affairs, Deputy James Reilly, and the former Minister of State with responsibility for primary care, now Minister for Communications, Energy and Natural Resources, Deputy Alex White.

The Bill will provide for a GP service for all children up to the age of six years as the first phase of universal primary care, central to which is access to GP care without payment of fees. A recent survey by the Pfizer Health Index found the Government's plan to provide a universal GP service to all children aged under six enjoys strong public support. It was suggested support for the initiative may be linked to the belief that families with young children have been impacted hardest by the recession. This Bill will be of great benefit to many middle class and working families who continue to struggle in their daily lives and who have to pay €55 to visit a GP and perhaps more again at the pharmacy. It will remove the need for many families with young children who are forced into deciding whether their child is sick enough to justify paying for a visit to the GP.

This legislation is not an end in itself. It is merely the next step in delivering on the Government’s vision of universal health care. A GP service for the entire population is in line with the programme for Government and provides a basis for further reform of our health service as we move from a service based on treating illness to one about good health and prevention and from one centred on hospitals to general practice and primary care.

I welcome the Minister’s acceptance of the amendment from the Seanad. It suggests there will be a different style at the Department of Health. While I wish the former Ministers, Deputies Reilly and White, every success in their new ministerial roles, their approach, particularly that of the former Minister, Deputy Reilly did not instil confidence in the legislation among GPs. The new Minister’s acceptance of this amendment suggests a different style of engagement which is welcome.

It is important that in accepting the amendment, the Minister is respecting the role of Seanad Éireann. This amendment was tabled by a Member there who is a medical practitioner. It shows the Upper House can be effective and change legislation. It is unusual for the Government to accept amendments from either the Opposition or the Upper House, so I welcome the Minister’s statement of intent in this regard. The provision of free GP care for children under six is important. However, when we cannot guarantee basic services to people with serious illnesses, we must be careful in the choices we make.

I wish the new Minister, Deputy Varadkar, every success in the Department. I have no doubt he will bring much energy and effort to it. It is a difficult Department. As the Minister said last week about its previous comparison to Angola, Angola is actually doing pretty well now.

Seanad amendment agreed to.
Seanad amendment reported.

A message will be sent to Seanad Éireann acquainting it accordingly.