As there are no amendments on Report Stage, we will proceed to Fifth Stage.
Health (General Practitioner Service) Bill 2015: Report and Final Stages
Bill received for final consideration.
Question proposed: "That the Bill do now pass."
It is my pleasure today to conclude the Dáil legislative process for what is a significant and important Bill. This Bill will provide for a universal GP service to be made available to all persons over 70 years of age and builds on the first phase for those aged under six years. Under the Bill, access to a GP service will be provided to all persons over the age of 70 years on a universal basis, replacing the existing GP service arrangements for those aged over 70 which is based on a means test.
Their dependants, including spouses or partners who are under the age of 70 years, will continue to have access to a GP service without fees where they meet the existing income limits. The decision to prioritise the over 70 cohort for the roll-out of the universal GP service had regard to the significant prevalence and comorbidity of chronic diseases in the population aged over 70. It is estimated that about 36,000 people over the age of 70 must currently pay to attend a GP because they are not covered by a medical card or a GP visit card. The annual cost of the system for those aged over 70 based on existing GMS GP costs is estimated at €18 million.
It is important to be clear that nothing will change for any persons over 70 years of age who have or are eligible for medical cards. They will continue to receive all of their other medical card entitlements as normal. The Government remains committed to the introduction of a universal GP service for the entire population, in line with the programme for Government. We are in the process of re-orientating the health system to one that only treats sick people to one that keeps people well.
The Government is committed to completing the most radical reform of the system in the history of the State to develop a universal system that treats all according to their health needs and not their means. While we are making progress on universal access to GP care, we also recognise that the health service needs to be responsive to the circumstances of people with significant medical needs.
Late last year, the Minister for Health and I announced a series of measures to enhance the operation of the medical card scheme and make it more sensitive to people's needs, especially where serious illness is involved. The medical card system is now operating in a more sensitive and sensible manner. Greater discretion is clearly being exercised by the HSE and the number of discretionary medical cards in circulation has increased by about 56%, from about 52,000 in mid-2014 to more than 85,000 at the beginning of this month.
When someone meets the crisis of a serious illness at any stage of life or a child develops a serious illness, one may be in a financial position to meet one's immediate needs or have those needs met by the hospital system. In general, that is what happens in Ireland and we all agree that the problem is access in terms of the health service. Once one is in the system and being treated, it is second to none, apart from the mishaps that often occur. We are not the worst in the world and most people, when they come out of the service, will say they have had a very good experience. The normal reaction of those who have been ill or their loved ones is that the service is good and responsive once one is in it.
We need to get away from the immediate instinct to go to accident and emergency in an acute hospital because that is where difficulties occur. People who are doing their very best to deliver a service often find themselves having to tell people that they should not be there in the first place. Access to a GP will ensure that we have a more defined delivery of care. It is about staying healthy, rather than concentrating on ill health. Universal access to a primary care system is not just about GPs; rather, it is about care as we age, for very young children or people with long-term chronic diseases.
Primary care is about recognising that one does not always need to go immediately to accident and emergency. Our aim in health should be keeping people well, as well as right across the board, in terms of paediatrics, gerontology, mental health and physical well-being. I have said many times in the recent past that people did not have a great interest in mental health and that is why A Vision for Change garnered universal approval. I am not certain which one of us read it in any great detail in terms of how it would deliver a service but surely if we can agree on the principles of what we want from health, we can also agree a pathway to ensure it is delivered.
This Bill will deliver universal GP care to the 36,000 persons aged over 70 who do not at this time have access to a medical card or a GP visit card. By the summer all 800,000 people aged over 70 and under six will be able to visit a GP without facing a financial barrier, which will be a significant step towards a universal GP service for the entire population. I commend the Bill to the House.
I know the House will be interested to hear that as of now well over 50% of doctors have signed up to the new contract. I have no doubt that there will be issues, but what system is perfect? We are convinced that by the end of the summer we will have those aged over 70 and under six covered. The sign up for those aged under six and over 70 will begin on 1 July and 1 August, respectively. There is an issue of timing to ensure that the system can cope.
I welcome the conclusion of the Bill. I agree with everything the Minister of State has just said but, unfortunately, the reality on the ground is so different from what she is working towards. We have a general practitioner system that is in a fundamental crisis and has been for some time.
When one is not near an acute hospital, one uses one’s GP. I often remember the case 20 years ago of a visitor to Ballina asking where was the nearest acute general hospital. When I informed her it was an hour away in Castlebar, she nearly dropped. I then explained to her that we simply went to our GP. Now, however, we are struggling to get GPs in rural areas. Although it was once seen as a fantastic career, rural areas now cannot be guaranteed a GP service. Of course, in such instances, people will have to go to the hospital even if it is an hour and a half away. We have had instances of this in Bangor and Glenamoy recently.
While there are more pharmacies, we need to embrace their services and use them more to keep people out of the acute hospitals. Unless we resource our GPs and refuse to accept that our best and our brightest GPs need to be in Canada or Australia to make money, and unless we actually make it a viable business once again, and not just as a supplier of primary health care, then I am afraid the Minister of State’s vision will not happen. We will lose younger GPs and those coming out of medical college will not sign up for the life of a GP unless we resource general practice and bring back the rural practice allowance as a guarantee.
The HSE seems to have washed its hands of this, and the Department moves on a case-to-case basis. Someone whose child is diagnosed with an illness should not have to face the trauma of a delay, even if they are financially secure, but that is the reality. We have all dealt with cases in which there have been delays. The team dealing with medical cards at the primary care reimbursement service is working under huge pressure but is always helpful. The members are an example to other civil servants in their helpfulness and in the provision of information. I thank them for that. However, we should not have to be ringing them. There are still many over-70s falling between the cracks, particularly if they are diagnosed with conditions such as dementia or Alzheimer’s. I am dealing with one horrendous case in which the people in question have the resources to deal with it but they are facing ten years of treatment. They will not have the financial resources in the end unless they get support now. The system does not seem to be able to comprehend that many illnesses will not be cured in the short term but in the long term. People will have to make arrangements around that, but our system is struggling to cope with it.
I certainly agree with the Minister of State’s vision and I have no doubt she is doing her best, but it is not happening. There are still vacancies for consultants because the contract is still not attractive enough to bring our own home, to give them the freedom to do academic research and the private practice they need to engage in. Why do we have so many vacancies on the consultancy front? The legacy of the contract introduced by the former Minister, Deputy James Reilly, is still there and still raw. We have to make this place one to come to.
Today, we saw a massive increase in outpatient waiting lists in general hospitals across the country. Once people get in, they generally get a good service. It is getting harder to get in, however. While we continue to undermine our primary care service, unfortunately, the delays will get harder. Unless we give the National Treatment Purchase Fund the power to get into that space and shake it up, those waiting lists are going to increase.
I apologise for the long sum-up, but the Minister of State gave me some thoughts. This Bill is an improvement, but the health system is under enormous pressure at the moment. Those working in it are fantastic, but we need more working in it, as well as more proper spending and resources.
As I indicated on each of the previous Stages, I will be supporting this Bill’s final passage. I hope the outworking of the legislation and its provisions will prove beneficial to all to whom it is intended. It is important to recall that my support for this particular legislation, and indeed for the provision of free GP access for children under six, was in the context of the roll-out of universal access to free GP care. That was a position I took with the former Minister of State, Deputy Alex White. I know we were on the one page in that respect. I cannot emphasise enough how important it is that we programme that for the earliest possible timeframe. Otherwise, we will perpetuate yet another difference within the system - a two-tier situation, with the under-sixes and over-70s and everybody else. That simply is not acceptable. The delivery of universal entitlement must be by the shortest possible route.
Listening to those voices from the GP representative organisations, the most common criticism levelled against the two Bills in this area, particularly the one regarding the under-sixes, is that children over six who are unwell will not be accommodated while the many well children under six will be provided for. That in itself must be a further incentive to move with the greatest possible speed to the roll-out of universal health care. From the overwhelming majority of GP commentators, I do not note any resistance to moving towards universal free GP care. On the contrary, there seems to be quite strong support for such a system. The earlier we can reach this, the better. If it were signalled at this point that greater speed was intended, it might even help by ensuring a greater take-up of the provision for the under-sixes and the over-70s in turn.
The legislation also promises something I raised on Committee Stage - namely, doctor choice. I know we both have the same understanding on this. Regrettably, however, in great swathes of rural areas, as well as in considerable numbers of large urban areas, doctor choice is a significant problem. People will not have GP choice when there is a continuing depletion of GPs across the country. It is important to recognise that GPs feel poorly dealt with over recent years. They have taken a number of significant cuts in service provision and this has had an impact on their respective individual or shared practices. We have to resource primary care. That is the bottom line. We must resource primary care if we are to ensure that the cohort of general practitioners across the country has the capacity to cope to ensure people are not, through displacement, moving towards accident and emergency centres at our network of hospital sites. We want to encourage a system whereby the first point of contact with the health services is at GP level. That cannot be done if the necessary numbers of general practitioners and practices are not available.
I am sorry to interrupt the Deputy, but we must conclude and move on to Private Members' business.
The Leas-Cheann Comhairle is quite right - it is a very important matter.
We can conclude this or we can-----
I will conclude in our shared interest. We could very well be beneficiaries of this measure in no short time. I hope the points I have made previously and again this evening were well made and will be taken up by the Minister of State.
Question put and agreed to.