No U-turn on free GP care from this administration

May 20, 2013 § 1 Comment

Since I was appointed Minister of State at the Department of Health last October, many have asked me whether I felt I had been handed a “poisoned chalice”, or indeed a “hospital pass”?

A previous minister for health is said to have referred to his department as “Angola”, on the basis that it was filled with unexploded landmines.

Health is neither Angola nor a poisoned chalice. Remarkable changes in our social and individual wellbeing have been effected through health policy.

Average life expectancy in Ireland is at its highest ever and is above the EU average. Death rates from a variety of life-threatening conditions have fallen, in some cases halved, in less than 20 years.

The impact of diseases and conditions that damage quality of life is being mitigated year on year.

These developments owe much to advances in medical science and to the effectiveness of our medical professionals. But they are also due to policy decisions to fund new treatments and services and to deliver them to the public in as effective a way as possible.

Holistic approach
My area of responsibility is primary care, the first port of call for citizens seeking access to the health services. At primary care level, there is a holistic approach to health and wellbeing.

As well as being treated when they are sick, people receive advice, support and guidance to help them avoid illness in the first place.

It therefore makes sense for people to have easy access to their GP, to have health problems identified before they get serious and to get help on how to manage aspects of their lifestyle before they cause problems such as diabetes and other conditions.

It not only makes sense for individuals, it makes sense for government too. Primary care is a lot less expensive than high-tech hospital care. If illness can be avoided or managed before someone ends up in hospital, this results in a better outcome for the patient and is a more effective use of scarce resources.

This is why in opposition the Labour Party championed the idea of universal free access to GP care and why, along with our Coalition partners, we have pledged to introduce it.

Translating sound policy objectives into practice is the real business of government, and implementing universal GP care is a case in point. The idea was to start with claimants of free drugs under the long-term illness scheme. A year later, access to primary care without fees would be extended to claimants under the high-tech drugs scheme. Subsidised care would be extended to all in the next phase and, finally, it would be free to all.

It has become clear to me that this approach is too complex and likely to be extremely cumbersome in practice. It would mean introducing new legal and administrative arrangements to ensure free GP care went to those for whom it was intended, potentially even requiring ministerial regulations setting out the diagnostic basis for each chronic illness. And all of this for just one phase of a much bigger project: extending to the entire population GP care without fees.

So I concluded we should try to introduce it in a different way – a way that ensured it happened more smoothly and efficiently. I explained the situation to the Cabinet committee on health last month and it agreed I should rework the proposal and come up with a better option for phasing in free GP care.

This could involve, for example, starting with people in a certain age group, or people on incomes below a certain amount and then extending the scheme progressively.

We haven’t fixed on a model yet but we will do so in a way that helps expedite the plan, rather than one that causes further delay.

There is no “U-turn” on the plan to bring in free GP care. There is simply a change in how it will be done. And it will be done.

That’s government. It is not a poisoned chalice, nor a hospital pass. It is, however, sometimes a complicated and unwieldy process. We are pressing ahead with our plan to ensure that everyone has access to the highest quality care based on medical need alone. Free access to GP care for all will contribute enormously to this.

 

Progress made in the universal GP care plan

May 15, 2013 § Leave a comment

The Government is committed to introducing, on a phased basis, a universal GP service without fees within its first term of office, as set out in the Programme for Government and the Future Health strategy framework. This policy constitutes a fundamental element in the Government’s health reform programme. There has been no change to the Government’s over-arching commitment to this goal. This Government is the first in the history of this State to have committed itself to implementing a universal GP service for the entire population.

Having examined the progress made in the universal GP care plan, it became clear to me that the legal and administrative framework required to provide a robust basis for eligibility for a GP service based on having a particular medical condition is likely to be overly complex and bureaucratic for a short-term arrangement. Relatively complex primary legislation would be required in order to provide a GP service to a person on the basis of their having a particular illness. The assessment system for such an approach would have to be robust, objective and auditable in order to have the confidence of this House as well as the general public. This legislation would have to address how a person could be certified as having such an illness, and who could do this, and how to select the diagnostic basis for medical conditions. As well as primary legislation, there would be a need for secondary legislation to give full effect to this approach for each condition. While it would not be impossible to achieve this, it would take several months more to finalise the primary legislation, followed then by the preparation of statutory instruments. In my view, this would entail putting in place a cumbersome legal and administrative infrastructure to deal with what is only a temporary first phase on the way to universal GP service to the entire population.

The Cabinet Committee on Health has discussed the issues relating to the delay in the initial step of the roll-out of the universal GP service. In doing so, it has considered the importance of weighing the balance between, on the one hand, resolving the legal issues but with a further delay and, on the other hand, the need to bring forward an important Programme for Government commitment with the minimum of further delay.

No decision has been taken by the Cabinet Committee or by Government on changing the first step of the plan to extend GP care without fees to persons with chronic illnesses. Instead, it has been agreed that we should prepare and set out a number of alternative options with regard to the phased implementation of a universal GP service without fees.  Minister Reilly and I expect to report back to the Cabinet Committee in the near future. As part of this work, consideration will be given to the approaches, timing and financial implications of the phased implementation this universal health service. 

The Government has already made clear its commitment to delivering on the implementation of a GP service for the entire population by providing additional financial resources in the two most recent Budgets. The HSE Vote now contains funding of €30 million for this year for an initial phase of the provision of GP services as part of this Programme for Government commitment.

 

Government Publishes General Scheme of the Protection of Life during Pregnancy Bill 2013

May 1, 2013 § Leave a comment

At its meeting today, the Government approved the drafting of the Protection of Life during Pregnancy Bill 2013.

It has agreed to refer the General Scheme of the Bill to the Joint Oireachtas Committee on Health and Children and to request that it should review the Scheme and report on its deliberations to the Minister for Health.

The General Scheme of the Bill is also being published tonight.

The Government established the Expert Group on the Judgement of the European Court of Human Rights in the case of A, B and C v Ireland, in accordance with its commitment in the Programme for Government.

The Report of the Expert Group set out the very many difficult and complex issues which the Government faced in formulating its proposed legislation.

The provisions of the legislation being published are strictly within the parameters of the Constitution and of the Supreme Court Judgement in the X case.

The proposed legislation sets out a clear legal framework for women and for medical practitioners in Ireland.

It will provide legal clarity for the medical profession of the circumstances where a medical termination is permissible where there is a real and substantial risk to the life, as distinct from the health, of a woman as a result of a pregnancy.

A copy of the General Scheme can be found here:

http://www.merrionstreet.ie/wp-content/uploads/2013/04/Protection-of-Life-During-Pregnancy-Bill-PLP-30.04.13-10.30.pdf

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