If there is any change, it will clearly be the result of the pressure being put on the Government by the Labour Party and others in the House. We are united in highlighting this essential matter.
In the last four years Ireland has become an increasingly wealthy and, at the same time, increasingly unequal society. We have one of the highest levels of income inequality in the European Union. The gap has widened dramatically in the last four years. The top 10% of the population now have disposable income 13 times greater than the poorest 10%. This has not happened by accident, rather it is the legacy of an ideologically-driven Government which continues, even to this day, to deepen the divide. Nowhere is this divide more evident than in our health service.
We have great health professionals working to deliver care to their patients, but they work in a uniquely dysfunctional system which discriminates against the poor in favour of the rich. We have a two tier health system based on a kind of Irish apartheid which would not be tolerated in any other EU state and which is rapidly becoming unacceptable to the broad majority here. The public is ahead of the Government in its desire for change. People are genuinely appalled at the discrimination which ensures, at hospital level, private patients can access the quality care they need when they need it while public patients often end up on long waiting lists. Even a visit to the family doctor is not exempt from injustice. Those on very low incomes who do not have medical cards are forced to pay the full price to see their family doctor or do without the care they need and suffer the consequences. Such people include the single person living alone whose income exceeds £100 per week or the married couple with two children living on an income of just over £9,000 per year. These are people who are already struggling to pay their household bills and for whom a medical bill constitutes a crippling burden. If other European citizens do not tolerate such inequality, why should we?
Last week the Minister for Health and Children, Deputy Martin, launched his health strategy. It was the occasion of lavish PR, clever media management and a benign, if bewildered, public response. It was also four years overdue. Starting out in government with a strategic policy makes good sense. Waiting until the dying months of an Administration leaves the Minister vulnerable to the criticism that this was a political stunt. Be that as it may, there are some good elements in the health strategy, though it is still a failure. It fails to address the central challenge of health care reform. It does not deliver equality. Despite its title, Quality and Fairness, it is a ten year plan designed to perpetuate unfairness in health care. That was a disappointment in itself, but worse was to come.
Two days later the Government's primary care strategy was launched and the result can only be described as a disaster. An overly ambitious billion pound plan was reduced to tatters when the Minister admitted that, far from delivering equality at primary care level, the Government had decided to freeze any increase in income limits to qualify for a medical card for the duration of its lifetime. It is a decision that has been described as deeply disappointing, callous and cruel and even as obscene. It is also a decision that can be reversed, which is the reason the Labour Party has tabled this motion and it is seeking majority support across the House.
The first line of the Government document states, "Primary care is the first point of contact that people have with the health and personal social services." The harsh reality is that for thousands this is simply untrue. They cannot access primary care because it costs too much. They end up in accident and emergency departments because their health has deteriorated or it is their only route to treatment. The Government is on record as stating that an additional 200,000 or so people should have medical cards. We, in the Labour Party, go further by asserting that primary care should be free at the point of delivery. Even if the Government was simply to live up to its own commitment, it would make a significant difference to the lives and health of up to 250,000 people on low incomes. The Minister justified his decision to exclude them on the grounds that their unmet needs would put pressure on the service. This is a terrible admission. Is he really saying the unmet need is so great that he cannot set about meeting it now?
It is clear that general practitioners – they should know since they deliver primary care – do not agree with the Minister and they are so keen for this improvement to be made now that the Irish Medical Organisation has issued a strong warning to him by stating that failure in the forthcoming budget to commit to the extension of the medical card would be a failure to meet the health care needs of the 250,000 who need it most. This, the IMO stated, would only lend currency to those who say the health strategy is no more than an expensive election ploy. A leading GP, Professor Tom O'Dowd, revealed that a recent survey in his practice showed that a quarter of his patients were put off going to the doctor because of the cost. I hope the Minister does not try to convince us that we cannot afford to extend medical cards to the people concerned. The recently leaked value-for-money audit carried out in the health service found that the current medical card scheme is excellent value for money. Nevertheless, the Minister is ignoring that expert opinion as well as the opinion of medical practitioners.
When the Minister extended medical cards to the highest income group among the over 70s he got it wrong. He introduced inequity into the GMS system for the first time. General practitioners are rewarded three or four times as much to care for this group of medical card holders as they are for caring for the poorest in our society. The Minister has thereby introduced, for the first time, incentives to attract GPs out of areas of deprivation and to set up practices in high income areas instead. Already we know that in areas of deprivation there are up to three times fewer GPsper capita, yet the only significant legacy of a Minister who has talked about fairness in the health service has been to make that service more iniquitous. When the Government took the decision to extend medical cards to the over 70s, it did not get its sums right. It estimated 30,000 would apply according to a reply to a parliamentary question I tabled some time ago. Already, 52,500 have applied.
The Minister says his decision results from setting priorities, but does not explain the reason he ignored the advice of doctors, value for money experts and even his own officials. The chief medical officer in the Department of Health and Children in his annual report on the health of children stated:
Specific policy measures, which redistribute resources and provide opportunities and services for families with children, especially poor children, will do most to create better health provision. For this reason basic universal health provision, such as free access to primary care for all children, should be considered.
Despite the good advice and promises made by the Government, the Minister has turned a deaf ear. On Monday he launched a health strategy which promised that "significant improvements will be made in the income guidelines in order to increase the number of persons on low incomes who are eligible for a medical card." By Wednesday the truth emerged that this commitment was not worth the paper on which it was written. It seems the Minister was so bedazzled by his ten year primary care plan that he could not see the real needs to be met.
The Labour Party recognises the central role of primary care in good health care delivery, but we warn the Minister against trying to import into our system the clapped-out British ideas from the 1970s upon which his strategy relies so heavily. He ignores the strengths of the Irish system at his peril. It is vital to maintain and enhance the personal relationship between patients and their doctors. We oppose any proposal which puts barriers between patient and doctor. The proposed triage system could end up with a patient having to get approval from another health professional before he or she can access his or her doctor. No member of the public seeks such a change. It is not good practice and unnecessary. It is also not within the Irish tradition of personal health care. In Ireland people who can afford it or are on medical cards have direct access to the general practitioner of their choice. What is being sought is that such access be guaranteed to 200,000 people on low incomes in order that they can have the security and access for themselves and their children which is denied to them.
If the Minister is serious about primary care reform, he should also commit himself to a free GP service at the point of delivery as the Labour Party has done. He should be less grandiose in his plans to reform primary care and concentrate on the needs of patients. There is nothing to stop him from extending the medical card scheme as the first step towards a free GP service, encouraging the growth of group practices, integrating community nursing with practice nursing, providing incentives for GPs working in areas of high deprivation, guaranteeing patient registration by way of a comprehensive GP scheme, ensuring the regulation and standard-setting concerning out-of-hours emergency services, whether by co-op, rota or commercial deputising, or building the capacity of primary care to deal with prevention, rehabilitation and the management of chronic long-term illnesses. These measures would significantly improve Irish primary care while retaining its strengths and making it more accessible. We, in the Labour Party, propose real reform of primary care rather than the overblown proposals from abroad upon which the Minister sets such store.
The motion is of great importance to people throughout the country. I have no doubt as the debate continues that clear evidence will be given about the suffering and hardship caused as a result of people being unable to access their family doctor. I urge the Minister to accept the motion. He has a chance to put right a terrible wrong being done to families and children who are denied a basic right to medical care. Surely the time has come when the Government and the House can make a simple guarantee of quality and fairness to those who need it most.