Dáil Éireann Debate, Wednesday - 16 May 2012
6Deputy Micheál Martin asked the Minister for Health the consultations he has held with general practitioners regarding the extension of free care to those with long term illnesses; the expected cost of this scheme; and if he will make a statement on the matter. [24288/12]
Amharc ar fhreagra37Deputy Charlie McConalogue asked the Minister for Health if he has consulted with the Irish Medical Organisation regarding the provision of universal general practitioner care; and if he will make a statement on the matter. [24290/12]
Amharc ar fhreagraI propose to take Questions Nos. 6 and 37 together.
The programme for Government commits to reforming the current public health system by introducing universal health insurance with equal access to care for all. As part of this reform programme the Government is committed to introducing universal GP care within the term of office of this Government. I have established the universal primary care project team which has been tasked with working through the issues relating to the introduction of this commitment. Officials from the Department and the HSE are represented on this project team. The project team has been meeting regularly, approximately fortnightly since February.
The Government has given its approval to the preparation of heads of a Bill to progress the phased introduction of free GP care in line with the programme for Government. I intend that this Bill will be published and enacted prior to the summer recess. It is envisaged that the first phase in the programme will provide for the extension of access to GP services without fees to persons with illnesses or disabilities to be prescribed by regulations under the new legislation. A provision of €15 million was made available in the 2012 Estimates for the first phase of the programme.
I have had preliminary discussions with the IMO and the Irish College of General Practitioners to outline policy in this area. I expect to engage in further discussions with GPs and the IMO at the appropriate time.
This will involve a contractual change in terms of how the Department assesses medical card qualification because up until now it was based on means, not on illness. This change will involve contractual discussions with GPs. The GPs represent the front line in the delivery of care, as the Minister for Health, Deputy Reilly, more than anybody else, will be aware. We are talking about the establishment of primary care units and primary care teams, and the GP will be the focus.
If the legislation is to be published in the middle of this year and enacted thereon, surely there must be some form of discussions and contractual changes with GPs in the country to deliver this new service because it will impact on their contracts.
Would the Deputy raise a question?
I apologise for interrupting. There is a lot of noise coming from the background and I cannot hear the speakers.
Could we get clarity as to whether the Minister intends to sit down on a formalised basis with the IMO and others to tease out the issue of the contractual changes that will be required in the implementation of the first phase of free primary GP care?
In terms of the funding of this roll-out and the fact the Minister is talking about having free GP care available to everybody by the end of the term of the Government, has he analysed the charge on the Exchequer? While we are talking about free GP care for everybody, we are currently, in Kilkenny and Carlow, counting the number of incontinence pads being given to persons in nursing homes. As we speak, they are rationing incontinence pads. I am in favour of trying to make GP care available to as many people as possible, but in the meantime that is what we are doing to the elderly in nursing homes in the State.
That issue of a limit being placed on incontinence pads should never have arisen and that decision has been reversed. It is no longer the case. It was unfortunate it happened, it should not have happened, and it has been dealt with.
On contractual changes, it is not envisaged there will need to be a change to the GP contract to begin the process of introducing free GP care. It is true what Deputy Kelleher stated, that the existing system operates on a means basis. That is why we are introducing legislation to enable us to provide by regulation for certain categories of person to be given a doctor visit card. That is the purpose of the legislation.
We do not foresee that causing difficulties with or any concerns about the contract. What we have seen over recent years with the recession is a big increase in the number of medical cards issued and GPs have taken on that additional work. There is no reason the extension of the doctor visit card should cause any difficulty. I do not foresee that being a problem.
I have had informal discussions. I made it clear to the ICGP from the beginning. I outlined Government policy, the plans we are making and the preparatory work that is under way through the universal primary care project team. I also met the IMO on a couple of occasions recently to outline the preparatory work that is going on. We will be engaging more closely as the legislation develops. We are applying a good deal of pressure to get it through before the summer.
In the context of long-term illness, as far as I can ascertain in research, there has been no long-term illnesses added to the scheme since the mid-1970s. Will there be an extension of the illnesses that will qualify as long-term illness? Motor neurone disease, asthma, bipolar disorder and many others are not part of the long-term illness scheme. In the context of the roll-out of free GP care for those who are on the long-term illness scheme, will there also be an extension?
I have a slight difficulty when the Government talks about free GP care for everybody. Free GP care for everybody sounds great, but the difficulty is there are many who should be entitled to free GP care who are not getting it and the Government is talking about this grand design and plan of rolling it out to everybody. In the meantime, there are people dying of motor neurone disease or many other major long-term illnesses who will not qualify. Will the Minister of State carry out a review of the long-term illnesses and diseases that will qualify for same?
As I outlined, in situations where people are dying, special arrangements are in place to provide medical card cover, details of which have been circulated to all Members of this House.
I accept that.
The Minister of State, please.
Let us be clear about that.
Qualification of diseases.
The Government is committed to introducing free GP care within its term and it will be over a four-year period. The issue is the phasing of that and identifying the best way in order that we can do it in a controlled way to ensure the budget does not run out of control and the system is geared up. We are aware that primary care is underdeveloped. We want to see more GPs involved and more practice nurses and other allied health professionals. We must gear up. That is why it is being phased over a number of years.
There are different ways of dealing with the issue of category of person but we are trying to do it logically and within the budget provided. I accept the point the long-term illness scheme is problematic. It is far from ideal. In phasing in free GP care, we are trying to look at how we can target those not covered currently by a medical card but who are the most sick, and those within the long-term illness scheme are part of that. We will look then at other groups to whom we will extend the free GP care. That is why we are talking about enabling legislation and it is why we will look in greater detail at the nature of the regulations we will introduce, which will enable us to include the greatest number of persons in the greatest need within the budget available to us.
When will the promised costing structure of the proposed health reforms based on health insurance be available? This has been signalled for some time. Can the Minister of State give Members an indication as to when that will be available?
Will the Minister of State clarify the step approach to the roll-out of GP care for all? Is it on a two-step basis - those who currently hold the long-term illness card and then all citizens - or on a category-by-category phased basis? Can she give the House some sense of how many steps there will be towards the ultimate roll-out? Is there a timeframe in which she expects that to be concluded?
On the bigger questions about funding and the model, as Deputy Ó Caoláin will be aware, the Minister, Deputy Reilly, established the UHI implementation group earlier this year. That expert group, drawn from a wide range of expertise in different fields, has been tasked with drawing up a White Paper on UHI, and the aim is to have that White Paper before the end of the year.
Separately, I established the universal primary care project team, which is working through all of the issues involved in developing primary care. It is not only about the introduction of free GP care. It is about all the other elements as well - ensuring there are sufficient allied health professionals in the right places and there is decent accommodation for primary care centres. Work is also being done in respect of the contract. Many different issues are being addressed and one of the most important of these is ring-fencing the budget relating to primary care. The budget in respect of such care has never previously been ring-fenced.
We are going to phase in the introduction of free GP care this year, starting with the category of people to whom I already referred. The budget for this year is €15 million and we expect to have a similar amount next year. We are working through how we might devise the regulations in order to ensure the phasing-in process is done in the most appropriate way. We do not want to become involved in the expensive business of means testing. We are, therefore, taking the approach of identifying different categories, namely, those which contain people who are most sick, and ensuring they will be included in the initiative at as early a stage as possible. The overall timescale will be four years. Everyone will eventually be covered by then.
So it will be more than a two-step process.
It will be a four-step process at least.
