Get well wishes from the nation

TOPPING the Budget wish list of health representatives is a plea to the Government to fulfil its promise to extend the medical card scheme to an extra 200,000 people.

Family doctors, consultants and patients’ groups were devastated when the November Estimates failed to make any provision for extending the GMS scheme, first promised at the launch of the Government’s Primary Care Strategy in 2001 and reiterated in its election manifesto in 2002.

Irish College of General Practitioners (ICGP) chairperson Dr Richard Brennan said failure to extend the scheme would create an even greater inequality within the health service.

“Healthcare professionals recognise that there is a degree of poverty in the community. People on the minimum wage who are not covered by the GMS scheme are at a severe disadvantage in terms of accessing GPs, or any form of medical care or even medication. We would ask the Government to reconsider the GMS income threshold.” The proportion of the population eligible for medical cards on income grounds has fallen to 27.7%, the lowest level since the GMS scheme was introduced in 1972. Individuals on incomes above 138 a week and married couples on over 200 fail to qualify for cards. Each child adds an additional 25 to that ceiling, so that a family of four fails to qualify on an income of over 250.

Irish Patients Association (IPA) spokesperson Stephen McMahon said if the Government was not going to extend medical card eligibility, then it must make some form of budgetary concession to those just outside the GMS qualification limit. “Already those on low incomes who do not qualify are looking at increased A&E charges, increased monthly drugs costs and increased in-patient costs. All these are barriers to people accessing the health services,” he said.

GPs are also looking for further investment in primary care. Dr Brennan said: “The Primary Care Strategy was announced two years ago and at the current rate of investment, it will take 50 years to implement. We know the health debate tends to focus on the acute hospitals, but most healthcare professionals recognise that primary care holds the key to solving many of the problems in the health services.

“About 90% of the medical needs of the population could be met in properly developed primary care settings. We estimate 60% of those attending A&E are not true A&E patients and should be accessing primary care.”

Dr Brennan said the ICGP would like the Budget to provide tax incentives to GPs to operate public-private partnership practices in more deprived areas, as part of its investment in primary care. The Irish Hospital Consultants Association (IHCA) wants the Government to prioritise in investment in step-down facilities to free up acute hospital beds.

“There is an enormous waste of acute hospital beds. Up to 20% of acute beds in the Dublin region and 5% nationally are occupied by patients who could be accommodated for a fraction of the cost in nursing homes,” said IHCA secretary general Finbarr Fitzpatrick.

The changes proposed by the Hanly report, which recommends an extensive restructuring of the acute hospital system, must also be funded, said Mr Fitzpatrick.

The Irish Nurses Organisation estimates 1,000 extra beds need to be brought provided in 2004, with no bed closures. It wants immediate initiatives to address chronic shortage of nurses and midwives; the removal of workers on the minimum wage from the tax net; a commitment to maintain the living standards of PAYE workers and those relying on social welfare payments and the widening of the tax base to ensure all members of society pay their fair share.