Pádraig Rice
Cork South-Central · Social Democrats · Ireland
“There is no clinical reason this should not be extended to oral contraceptives. Pharmacists are highly trained healthcare professionals. They should be allowed to operate at the top of their licence. They are available in every community and are very accessible.”
“I welcome the Bill. We spend a lot of time inside these Houses talking about other parts of reproductive healthcare and not enough about contraception, so it is really welcome that we are having a focus and discussion on it and are moving forward with changes.”
“The oral contraceptive pill has been around for well over half a century and is one of the safest and most well-studied medicines available. In 2019, the World Health Organization publicly stated that oral contraception should be available without needing prescription.”
“I move amendment No. 8: In page 5, between lines 20 and 21, to insert the following: “Report on prescription-free oral contraceptives 4. The Minister shall, within six months of the passing of this Act, prepare and lay before Dáil Éireann a report on a proposal to allow registered pharmacists to dispense prescription-free oral contracepti…”
“We are talking about the prescription of oral contraceptives as called for by the World Health Organization, as set out by the Irish Pharmacy Union and as endorsed by the previous health committee. We are looking for a report on that with the detail of the various elements, if more detail is required.”
“It is important that we allow pharmacists to operate at the top of their licence and give them as much power as possible, and alleviate pressures on GPs. As I said, this is recommended by the World Health Organization and endorsed by the previous health committee and the IPU. That is the background to this amendment.”
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“However, the absence of sustained, year-on-year funding has meant that too many people are not getting access to timely tests and treatment. The Irish Cancer Society has provided an overview of recent testing and treatment pathways. Last year, 6,200 people waited more than the recommended time for a colonoscopy. The target is zero patients within more than 28 days. Two in five women were not seen on time for urgent symptomatic breast disease clinics. The target was 95% seen within ten working days. In the first half of the year, seven in ten people waited more than three months for an MRI, while six in ten people waited over three months for a CT scan. Similar things are faced in terms of cancer surgeries in 2025. Two in five people did not have lung cancer surgery within the recommended 25 days.”
“However, multi-annual health service funding has been promised by every Government since 2016, yet none has delivered it. The Minister for Health should have insisted that it was delivered in this Government's first budget. Budget 2026 did nothing to advance multi-annual funding. Last year, during the Estimates process, the Minister told me that it was her ambition to progress multi-annual funding this year, subject to an agreement with the Department of public expenditure. We need to know if this is still progressing and if it will be implemented in budget 2027. The next cancer strategy must have multi-annual funding. Otherwise, it will suffer the same fate as the current strategy. There is no doubt that patient outcomes have improved over recent decades.”
“When the strategy was launched in 2017, the then Minister for Health, Deputy Simon Harris, promised substantial current and capital funding over the ten years of the strategy. However, as the motion notes, the strategy has not received dedicated development funding in every budget since. There is a direct link between this failure to fund the cancer strategy and the missed targets, staff shortages and rampant outsourcing. You cannot starve a strategy of funding and expect it to be a success. When the Irish Cancer Society appeared before the health committee last October, it was very clear about the need for multi-annual ring-fenced funding for the strategy. The programme for Government commits to developing a multi-annual funding approach for the entire health service.”
“I thank Sinn Féin for tabling the motion, which the Social Democrats will support. Cancer services were once the jewel in the crown of our health service and an example of what the system could achieve if sustained investment was matched by political will, but the focus on delivery has waned over the lifetime of the current strategy. As a result, we have delayed diagnoses and treatment, missed targets, shocking regional disparities, ageing infrastructure and major staff shortages, none of which were acknowledged by the Minister of State in his opening statement. To put it mildly, it was disappointing, particularly given the stories we have heard tonight. Ring-fenced funding for the cancer strategy has been sporadic over its lifetime.”
“Last week, just after receiving their exam results, they found out they would have to compete for their current positions and that this would affect not just the current paramedics but also those who are currently in training. All graduates and trainees had a legitimate expectation that they would be offered permanent contracts. Why has the rug been pulled from under them? At a time when the National Ambulance Service is understaffed and staff morale is so low, this is an act of self-sabotage. Many of these graduates have made major financial commitments including mortgages, rents and childcare, all based on the expectation they would be given permanent jobs in their current location, not in another region across the country. Will the Tánaiste do more than talk to the Minister?”
“-----which should give the Tánaiste a sense of the scale of the crisis there. For the first time, newly qualified paramedics are not being offered permanent contracts. Instead, this cohort of graduates are only being offered short contract extensions and the opportunity to reapply and compete for their own jobs. Up until now, paramedics who successfully completed the training programme transitioned directly into permanent contracts. In December, this cohort of graduates was given the same assurance that permanent contracts would be offered to them once they got their results from University College Cork, UCC, but this promise has been broken.”
“I welcome the announcement of the second vaping Bill, in particular the piece around prohibiting the sale of nicotine-consumption products such as pouches to under-18s and the piece around advertising. It is targeted at children. The bubblegum flavours and advertising target children in an aggressive way. I support limiting the flavours as well. As I said earlier, I was talking to some teenagers and they spoke of the use of vapes among fourth, fifth and sixth class students in primary schools. In a secondary school, one student I talked to said nearly everyone in second year of the school vaped. It is a real issue. Like Deputy Cullinane, I think the flavours could be limited while allowing something like menthol, which is a cigarette flavour as well, for those who do not want to smoke but will vape.”
“Okay, but every single amendment tabled in respect of this Bill has been refused. In the context of previous legislation, all the amendment that I and others have tabled have been rejected out of hand. We need to work together on this to ensure that we get the best legislation possible. We all support the Bill, and we are trying to get the best legislation possible. If there was greater willingness to engage on amendments in a more constructive way, it would ensure that we would have better legislation. Historically, the Oireachtas has not produced good-quality legislation that regular citizens can just pick up, read and understand. It has generally been complex and hard to follow. I say this as somebody who has spent a number of years studying law. We need to make our legislation simple and more straightforward.”
“I have not yet seen it accept a single amendment put forward by either Government backbench TDs or Opposition TDs during my time here.”
“Deputy Ward makes a very good point about legislation more generally. A citizen should be able to pick up a Bill, read it, understand it and see what is an offence and what is not an offence. It is a basic tenet of the rule of law that people should be to understand the laws they are expected to abide by. Even if it is the case that we have to go belt and braces, put these definitions in and spell things out in each section, we should do it. We should be able to pick up a Bill, read it and understand each section. Even if that requires a belt-and-braces approach, we need to put in the definitions to spell that out. The Minister of State should have done that here. I have a general point about the Department of Health's approach to legislation.”
“We might discuss it with our Seanad colleagues before then. I ask the Minister of State to look at what has happened in the UK and ensure the definition is watertight because we want to ban single-use vapes. I am happy to withdraw the amendment.”
“I ask the Minister of State and her officials to look at this again. I understand the Bill has not been in the Seanad yet. Perhaps she will look at what has happened in the UK in advance of the Bill going to the Seanad.”
“If we are modelling our legislation on the UK, where people are getting around a loophole in the law, that is not the law we should be implementing.”
“If the Minister of State is telling me the definition is the same as the one in the UK, then I am even more concerned. Reports from the UK indicate they are getting around the definition there. We have been hearing this from the vaping lobbying, Responsible Vaping Ireland. It is saying that in the UK, where a ban on single-use vapes has already been introduced, there are reports that some unscrupulous suppliers are modifying cheap, disposable devices by adding non-operable charging ports or including token, removable or rechargeable pods so products can be marketed as reusable, even though they are being discarded as single-use while not being single-use. Like those that I showed earlier, they have a fake charging port and look like they are refillable but they are not.”
“We must make sure that the ban is not rendered completely ineffective on day one thanks to the proliferation of these fake reusable vapes.”
“It looks like it is refillable but it is actually not refillable in any way and the charging port is only there for show, to make it look like it is rechargeable. Many disposable vapes are being sold with those detachable pods to give the impression that they are refillable but it is purely a token feature. It has been used to get around the legislation in other countries. Even if these were usable, there is very little incentive to do so as they cost approximately €10. We have already seen similar loopholes exploited in the UK and manufacturers will no doubt exploit the exact same one in this jurisdiction. I am not saying that the amendment is a silver bullet but the Minister of State and I could work together to ensure that the legislation is robust and watertight.”
“The current definition reads: “single-use vape” means a vape that is not designed or intended to be re-used and includes any vape that is— (a) not refillable, or (b) not rechargeable; The "not refillable, or not rechargeable" suggests choice, that is, not a disposable if it can either be refilled or recharged. This is why have suggested, "neither refillable nor rechargeable", in my amendment. This connects two negative possibilities rather than one option between both. The issue is that disposable vapes are now being sold with so-called "charging ports" to give the impression that they are reusable, but most are not, or at least not for more than a week. I have an example here. This vape has a little charging port on it. You can pull it out.”
“I move amendment No. 1: In page 6, to delete lines 5 to 8 and substitute the following: " "single-use vape" means a vape that is not designed or intended to be re-used and includes any vape that is neither refillable nor rechargeable.". The purpose of this amendment is to ensure that the definition of "single-use vape" is watertight and that fake disposables do not make it through. I continue to have a concern, which I raised on Second Stage, about the use of "or" in the definition of "single-use vape" and the possibility that it will be exploited by vaping manufacturers and suppliers.”
“I had a transition year student in my office recently who talked to me about 12-year-olds vaping in school and passing vapes around a primary school. It is a real issue. We have left it go too long and I am glad to see we have got progress on it tonight.”
“We need to take seriously how we order business in the House because it is not good enough and it needs urgent reform. I would ask the Cathaoirleach Gníomhach to pass that on to the Ceann Comhairle because it is an important point. I also welcome the progress on this Bill and the other proposed legislation. The two probably should have come together in one. However, like Deputy Cullinane, I welcome the move that has been made there and echo the sentiment. There is potential to limit it to maybe two flavours, or menthol, mint or something else, in order to ensure that people use vapes as a cessation tool. I welcome that progress having been made, in particular, that children will not be targeted by the advertising of those kinds of flavours because there is a real issue.”
“I want to voice my objection to the process here. It is poor form. We had it repeated last week, and again this week, in terms of the Government taking Committee Stage of legislation in the Dáil as opposed to at committee. As Chair of the health committee, I received a letter essentially telling me that my committee was too busy to even consider this issue, without any real engagement with the committee about our schedule or willingness to take this at committee. We would have been willing to take this at committee - it will be a short debate. We could have done this at committee. We did not need to keep all the TDs later here tonight to do this. We had it last week on the International Protection Bill. It is poor form. We have a dysfunctional Dáil.”
“Can the Minister confirm whether the arrangements in place with Blackrock are being examined in the overdue waiting list management audit and whether that will be considered in the report, and crucially, that all the outsourcing arrangements will be examined by the inquiry? Finally, I would like to mention the inquiry into Michael Shine and welcome the progress following the appointment of a facilitator. It is crucial that any ultimate statutory inquiry is victim-centred and adheres to their experiences and needs. Victims' stories must be listened to, and their questions must be answered. Above all, we must ensure that nothing like this can never happen again.”
“In relation to the outsourcing, only 19 children have had surgery abroad though outsourcing arrangements with the US and UK since 2024. During that period, 1,047 children have had spinal surgeries, meaning that only 1.8% of these surgeries have been outsourced abroad, despite the availability of €16 million. Last September, the Minister for Health said: "I am not satisfied with the international referral pathways and have lots of questions about why there is a decrease in international pathways and an increase in referrals to Blackrock. I fully accept that going abroad is not viable for many patients and families." Has the Minister got answers to these questions that she was looking for? Do we know what is happening, because, as of 7 November, CHI confirmed to me that 62 patients had been outsourced to Blackrock in 2025?”
“The CHI seems to be incapable of improving the waiting list. In January, there were 215 children on CHI's spinal service waiting list, unchanged from December last. A total of 128 children were on the active waiting list, up from 108 in December. There were 45 children waiting longer than six months for scoliosis surgery, up from 29 in December. Last year, 534 spinal surgeries were carried out, just 21 more than were completed the previous year. We do not know how many of these surgeries were on the same patient. This is important, because we know that children are returning to theatre for further surgeries. We also know that services are not keeping pace with demand, with 524 patients added to the waiting list in 2025. Therefore, there are real issues with the waiting lists.”
“However, there still seems to be some uncertainty about the terms of reference. Last month, the HSE told me: "The Terms of Reference for the External Expert Panel Review have been drafted and are under final review by the Chair and the panel members." Where does that stand? I also believe that the external expert panel review will take 12 months. Can the Minister confirm that whether that is the case and whether the legal issues with the Nayagam review will have any impact on this expert panel’s work? It would be good to know. I refer to the current waiting list because it is crucially important in all of this that we do not lose sight of those who are waiting today and those who are waiting to get access to services. The services need to improve in the here and now and we are not seeing the kind of improvements that we need to see.”
“There is a lack of information about infection rates. We do not know why spinal surgery infection rates are not being published. Parents want to know what the spinal infection rate was for 2024 and 2025, how these figures compare to international benchmarks and whether that data has been independently verified. We need to get as much information out in the open as possible and my experience of CHI is that it has not been releasing information. Officials have been not answering parliamentary questions as frankly as they should and there needs to be more honesty, transparency and accountability. I will briefly mention the audit into unnecessary hip surgeries. My understanding is that the external expert panel review commenced two weeks ago, which is welcome, although overdue.”
“If we are to have that effective public inquiry that we all want, let us get the information out there, let us publish that and let us ensure that there is a level playing field for all involved in this because it cannot be the case that the inquiry and the State have access to documents but parents and families do not. There is a real worry among families that will happen. We need to get a clear timeline on the publication of the waiting list management audit. It was due in November. Then it was due for February. The Minister is saying today it is April. Is that the last deadline we are going to have on this? It seems there is constant delay after delay. Is it the case that CHI is still withholding information? Is that what is holding it up? The lack of information released by CHI is concerning.”
“The Minister has said that for legal reasons phase 1 cannot be published but I do not understand how that was not foreseen. Is she confident that the entire report will be published later this year, when phase 2 is complete? There is not just the Nayagam report. There is also the Dickson report, the Arthur Cox report, the Crumlin report that referred to patients as "orphans" within the system and the waiting list management audit, and there are potentially other reports that we do not know about. All of this needs to be on the table.”
“All the information needs to be laid out and all sides need be furnished with the same evidence and information. That starts by publishing all of the information that is available and publishing all the reports because to date, what has happened is we have relied on whistleblowers. Without whistleblowers in CHI, we would know far less than we do. That is not acceptable. All of the information needs to be put out there. The Nayagam report was commissioned in 2023, yet it still is not fully complete. We learned last month that phase 1 is complete, but it is still not published. Issues were identified in the communication of that and the publication in a Sunday newspaper before families knew about it. One parent told me that they got a notice just 30 minutes before the Department briefing that the briefing was on and that they had not heard.”
“I would like a commitment from the Minister that there will be ongoing reporting and updates, and things will improve while this process goes on because we have to learn from the failures of the past. The State has gotten this wrong in the past when it comes to tribunals and public inquiries. They have run for years, in some cases decades. They have cost huge sums and they have not got the answers or the outcomes that we wanted. We cannot let that happen here. We need a robust public inquiry that gets us the answers and that changes things. It is crucially important that at the end of this we have better outcomes for families and that we have answers to the long list of questions that parents have. Crucial to having an effective inquiry from the start, all the facts need to be on the table.”
“It is crucially important that in the time ahead, that is rebuilt and families feel as included as possible so this inquiry looks at the issues they really want it to look at, such as waiting list categorisation and prioritisation, the decision-making, the variation in access pathways and the disparities in treatment. Crucially, it must get to the facts and identify all of the failures. The other thing families really want is for this public inquiry to release interim reports and not just wait until the end so we are not just waiting years for answers. The families want the inquiry to have reports and a statutory provision requiring that those be implemented in full and that those recommendations be put in place.”
“It is really important that happens not just on paper but in practice. Complex scoliosis was raised earlier and concerns raised with me about a fear among families that would be used to narrow the terms of reference. Parents have said they cannot find anything within departmental guidelines or CHI guidelines defining what complex scoliosis is. There is a real risk that will narrow the terms of reference from the start. In her conclusion, I would appreciate if the Minister could comment on that. One parent said the purpose of the statutory inquiry is to examine systemic issues and systemic failures do not confine themselves to diagnostic labels. That is an important point and maybe one we can tease out. There has been an element of trust being broken between families and CHI and the State.”
“It is crucially important that there is an independent statutory inquiry and there is nowhere left for anybody to hide so we get to the bottom of this and all of the facts, to identify all of the failures and to get answers to the long lists of questions that parents and families have. I would like a commitment from the Minister on the form of the inquiry and what she thinks would be the best form of inquiry. There needs to be a collaboration with the families over the coming weeks on the terms of reference. That is vitally important. In particular, the voice of the child and the voice of young people must be central to this. Many of these are in their late teens or early twenties and their voices need to be heard. They need to be included and not just talked about in the weeks ahead.”
“I welcome the updates on the inquiries and the opportunity to discuss scoliosis and spina bifida. Yesterday, I spoke to parents and advocates and they had three key asks. The first was the independent statutory inquiry, the second was the publication of all existing reports and background information and the third was action now on existing waiting lists for children who are still on waiting lists. What really struck me from that conversation was that I had a conversation with them just after the election and the things they asked for were remarkably similar. In fact, in some instances, they said things had gotten worse and not better. That is deeply concerning.”
“I wonder if the Aontú leader is happy with that. I ask him if he is on the side of the private insurance companies as opposed to ordinary people. What we have heard in this debate and from people across the country is that they want better access to GP services. They want the Minister of State to remove the cost barrier. They want her to make it free as promised, starting this year with under 12s and for the entire population by 2030. They do not want to wait weeks to access a service. We should increase capacity and the number of GPs. We have set out a detailed plan on how the Government can do that, and we urge it to implement this plan in full starting today.”
“That ultimately needs to change. There is also mention of the primary care centres. Roll out of primary care centres has been so slow with just six due to open this year. The C and AG estimates it will take another 13 years to deliver the primary care centres listed for delivery in 2012. That is a shocking rate of delivery and it really needs to speed up. I also address some comments made by Deputy Tóibín from Aontú, which seems to be the first party in the Dáil to depart from Sláintecare. That is notable. He should also read the report from the Department of Health, which says that while uptake increases when you provide free GP care that will level off. I also wonder whether Deputy Tóibín is happy for half the population to continue paying huge sums of money out of pocket just to see a GP. It is up to €100 to see a GP.”
“The Minister of State fails to recognise the real crisis in GP services. People are waiting weeks to get access to services and paying huge amounts out of pocket. There is constant mention of the GP review. That is now seven years old. We are waiting seven years for that and still the Minister of State comes in today and says we will get the review soon. Why does everything this Government does take so long? The common conditions services provided by pharmacists was also mentioned. The Minister of State said that is accessible to everybody. That is clearly not the case. You have to pay €30 or €35 to access that service even if you have a medical card. The most basic thing the Minister of State could do is remove that charge to make it free for everybody because at the moment not even medical card patients can access that new service.”
“We were meant to have free GP care by year five. Trust is broken, and it is up to the Government now to restore that, to get back on track and to deliver Sláintecare for the people. The deprivation grant was mentioned. We are calling for something different. It is not a one-off grant. We are calling for a change in the system, a weighted capitation, because we know the current system is not working. The new concentrated grant is not even being provided to some of the core GP services like GP Care For All, which did not receive the grant in the latest round. While the chronic disease management programme expansion is welcome, it needs to go further. We would like to see epilepsy included there. We would like to see severe and enduring mental health difficulties included. It needs to go further and faster.”
“Will it implement the 20 points we have set out in detail, and will it do so straight away? What we have in the Government, in particular from Fine Gael, is failed commitment after failed commitment. Fine Gael has now been in government for 15 years. That is almost my entire adult life. Back in 2016 it promised to roll out free GP care for children. We still do not have that and we are still left waiting. I therefore do not trust that the Government will do this, despite not opposing this motion. I urge the Government to get on with this and roll it out, fulfil the new programme for Government commitment for under-12s immediately and then set out a plan for universal healthcare for everybody by 2030. Sláintecare was mentioned, but the Government is not implementing it. The report was published nine years ago.”
“I thank Deputies from across the House for their support for the motion. GP services need more than a quick fix; they need an overhaul. This morning's debate makes that clear. I also thank those we engaged with on this motion: Deep End Ireland, the IMO, the Irish General Practice Nurses Educational Association and Doctors for Universal Healthcare, all of whom we met to discuss these proposals. I also thank the Rural, Island and Dispensing Doctors and the Irish College of GPs, whose research has informed the plan we put before the Dáil today. I also thank my own staff, Jake and Juliet, and the staff in the Social Democrats for their support. I want to respond to some of the comments made by the Minister of State, Deputy O'Donnell. He said the Government will not oppose this motion. That is welcome, but will the Government do it?”
“It is also important to say general practice is more than about doctors. GP nurses are indispensable members of the practice teams yet their value is under-recognised. This is why we want to see an alignment of the HSE rates for nursing pay as well in general practice. We in the Social Democrats except general practice needs more than a quick fix. What is needed is an entirely new approach to protect the unique value of general practice because the relationship between a patient and the GP is unlike any other in healthcare. Government cannot simply ignore this looming crisis in general practice any longer. A plan is needed, not a never-ending review. This is why the Social Democrats are proposing a 20-point plan to reform general practice. I hope the Government accepts it and implements it in full.”
“A new contract and new ways of working alone will not address the looming crisis in general practice and that is why our plan published today contains 20 proposals, including further measures to increase capacity such as strategic workforce planning, more training places and a new locum support service. In areas of deprivation more specific reforms are needed. That is why we are proposing a DEIS for GPs scheme. This will provide deprivation-weighted GMS capitation rates. Currently there is a significant jump in capitation rates for patients over 70 and while age is one of the most important determinants of health, it is not the only one and deprivation must also be recognised because patients living in disadvantaged areas have higher health needs at a much younger age.”
“The core GP contract is over 50 years old and even though it is has been amended many times, it is still not fit for purpose. For example, we are still expecting most GPs to provide their own buildings. We would not ask a teacher to build a classroom, so why ask a doctor to build a surgery? Why is it we still have not recruited HSE-employed GPs as recommended in the 2017 Sláintecare report? Surely it is a no-brainer, especially for underserved communities in rural areas and offshore islands. The ICGP research shows more and more younger GPs have no interest in the responsibilities that come with the traditional business model. They do not want to run a small business; they want to provide healthcare and this should not be too much to ask.”
“It costs nothing to see the GP in most European countries, including Austria, Czechia, Denmark, Estonia, Germany, Greece, Hungary, Italy, Lithuania, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia and Spain. If you are in Croatia, Bulgaria, France or Latvia you pay just €1 or €2 to see your GP while in Belgium and Luxembourg it costs no more than €7. In Cyprus, it is at most €15 and even at the higher end in Finland and Sweden, it costs on average €30. Meanwhile in Ireland the majority of people are paying double if not triple that to see their GP. This is not normal yet there is no sign of a plan from Government to change that. Hiding behind the strategic review of general practice just will not cut it any longer. That review was first promised in 2019 yet it still has not been completed seven years later.”
“However, the sad reality is 58% of the population are still paying up to €90 to see their GP, and that is just get in the door. Promises to remove costs have been broken time and again. The 2016 programme for Government committed to extending free GP care to all under-18s but a decade later all that has been delivered for children is an extra two years of free GP care; up from under-6s in 2015 to under-8s in 2023. The latest Government pledge is to deliver free GP care for under-12s. That programme for Government commitment needs to be implemented this year and a roadmap for delivering universal coverage by 2030 must be set out. GP care should be free. This might sound radical but it should not. Nowhere else in Europe would you be paying between €50 and €90 just to see the GP.”
“GP services are the bedrock of our health service but they are built on crumbling foundations. The warning signs of this looming crisis cannot be ignored any longer because timely access to GP care is a cornerstone of safe, effective and equitable healthcare. It is now almost nine years since Sláintecare was published. It was a ten-year plan to deliver universal healthcare based on need and not ability to pay. While Sláintecare is still Government policy, at least on paper, it now feels like delivering universal healthcare has been relegated to some time in the future and little more than a nice idea because if this Government was truly serious about delivering universal healthcare we would be well on the road to free GP care by now.”
“I move: That Dáil Éireann: recognises that: — access to timely General Practitioner (GP) care is a fundamental pillar of a safe, effective and equitable health service; — GPs play a vital role in our health service, managing the majority of people's medical care needs, and acting as the first point of medical contact for most patients; — GPs provide a core leadership role in delivering care outside of the hospital setting, and are central to the provision of Sláintecare's new model of integrated, multidisciplinary care; and — to continue the shift away from our current hospital-centric system, patients must have timely access to GP and community-based healthcare services that are free at the point of use; notes that: — Ireland is an outlier in Europe in not providing universal primary healthcare that is free at the point of need, instead, we have a system of eligibility which is determined primarily on the grounds of income or age; — according to the Health Service Executive (HSE) Primary Care Reimbursement Scheme, approximately 42 per cent of the population has access to free GP care through medical cards or GP visit cards, and the remaining 58 per cent pay out of their own pocket; — the cost of visiting a GP can range from €50 to €90; — in 2025, research commissioned by the Irish Cancer Society found that more than 30 per cent of people surveyed didn't attend a healthcare appointment because of cost; — the same survey revealed that 25 per cent of people prioritised other costs over their healthcare, including heating and eating; — a key recommendation from the Oireachtas Special Committee on the Future of Healthcare Sláintecare Report, published in 2017, was universal GP coverage by year five of implementation; — the 2016 Programme for Government committed to extending free GP care to under 18s, which never happened; — free GP care for children aged under six was rolled out in 2015, but it took another eight years before free GP care for children under eight was authorised in 2023; and — the 2025 Programme for Government commits to extending free GP care to children up to at least 12 years; further notes that: — the 2017 Sláintecare Report stated that the current GP contract was a barrier to a primary-care orientated health service, and recommended an entirely new contract to facilitate new ways of working; — the current GP contract is over 50 years old, and although it has been amended on numerous occasions, the core contract does not reflect modern day general practice, nor the future career expectations of young trainees and GPs; — research carried out by the Irish College of GPs in 2023, found that almost half of trainees, 48.1 per cent, were not prepared to take up the contract within a year of finishing their training; — the same research found that just above one third, 36.7 per cent, of graduates felt comfortable with the traditional responsibilities of the GP principal/partner position; — the need for better working conditions, greater flexibility and new ways of working has consistently been identified by the Irish College of GPs and the Royal College of Surgeons in Ireland, in their GP Retention Project; and — in April 2023, the Department of Health and the HSE initiated a Strategic Review of General Practice, which was due to be completed that year but is still ongoing, nearly three years later; acknowledges that: — according to the Economic and Social Research Institute, an additional 943 to 1,211 GPs will be needed by 2040; — while the Irish College of GPs estimates that 2,000 more GPs are needed due to current demand of our aging population and population growth; — in 2024, just two counties exceeded the World Health Organization's recommended ratio of 100 GPs per 100,000 of population, with areas of deprivation and rural areas worst served; — it is well established that there are higher and more complex health needs in areas of deprivation, yet there are fewer GPs working in these communities compared to more affluent areas; — it is estimated that Dublin's North Inner City has one GP for every 3,525 people, compared to the national average of one GP for 1,759 people; and — a third of the population lives in rural Ireland, yet the Irish College of GPs estimates that only 10 per cent of GPs work in these areas, with many in solo practices; further acknowledges that: — the Chronic Disease Management Programme (CDMP) has clearly demonstrated what general practice can deliver, when structural programmes, which align with Sláintecare, are implemented and resourced; and — last year, the HSE's report on GP-led Chronic Disease Management found that participants in the programme had 30 per cent fewer emergency department attendances, 26 per cent fewer hospital admissions, and 33 per cent fewer GP out-of-hours visits; is concerned that: — many GPs are overworked, burnt-out and increasingly overburdened with administrative work, all at the expense of their own work-life balance; — in the absence of reform, we are seeing the increasing corporatisation of general practice, with small family practices being bought up by investor-owned corporate entities with multiple locations; — a significant number of GPs are approaching retirement, with the Irish College of GPs estimating that 600 GPs are aged 65 or over, 300 of whom are aged 65 to 69, and 300 of whom are still working aged 70 and over; — according to an Irish Independent survey of 275 registered GPs carried out in 2024, more than half of the GPs could not accept new patients, with more than two out of three GPs in rural Ireland unable to take on new patients; and — there are critical gaps in out-of-hours GP services, and capacity constraints in daytime general practice are putting additional pressure on out-of-hours services; and calls on the Government to: — in the forthcoming budget, implement the Programme for Government commitment to expand free GP care to children up to 12 years of age; — immediately set out a clear timeline for the delivery of universal GP and primary care, which is free at the point of use, within the lifetime of this Government; — introduce a salaried GP model, with GPs directly employed by the HSE, for underserved communities, beginning with rural areas and offshore islands, and expanding into areas of deprivation and out-of-hours services; — create a new DEIS for GPs scheme, deprivation-weighted General Medical Services capitation rates, with a cap on list size, in recognition of the additional health needs of patients in deprived areas; — expand locum cover supports for GPs, by developing a nationwide HSE locum bank to ensure all GPs can take leave; — develop a new GP contract which facilitates new ways of working, meets the work-life balance and career expectations of younger GPs and trainees, and incentivises health promotion, public health work, disease prevention, and the delivery of integrated care; — invest in a national GP Clinical Lead role, to design, test and support new models of rural and remote general practice care; — establish a primary care health equity working group, with representation from frontline services and patients living in deprived areas, similar to the successful Scottish model; — accelerate the delivery of HSE-built primary care centres, to provide suitable premises for GPs and their teams, and support the delivery of integrated, multidisciplinary care; — develop a national strategy to attract, support and retain future GPs, and this should include increased exposure to general practice in medical schools, structured post-training fellowships, specific time spent in practices in both rural areas and areas of deprivation during GP training, and measures to support more diverse, flexible, and equitable career pathways; — accelerate implementation of the Irish College of GPs' 2023 report, entitled "Medical Student to General Practitioner - An urgent call to action"; — provide an additional 100 GP training places, through the expansion of training capacity in hospitals and supporting training practices; — implement a new model of out-of-hours GP care, which is uniform across the country, to ensure that access to out-of-hours care is consistent; — align general practice nurses' terms and conditions with their HSE colleagues, recognise and support general practice nurses' continuing professional development, and establish clear career pathways for progression; — increase annual public health nurse training capacity, from 160 to 240 places; — remove the Common Conditions Service fee for medical card holders; — provide universal access to the CDMP for all patients with type 2 diabetes, asthma, chronic obstructive pulmonary disease, cardiovascular disease and any further expansions such as the planned inclusion of chronic kidney disease; — expand the CDMP to include severe and enduring mental health difficulties, epilepsy and other conditions as appropriate, in consultation with GPs delivering the service; — develop a structured women's health programme for general practice, which deals with contraception, screening of STIs, fertility, pre-conception, endometriosis and menopause; and — develop a national GP data framework to provide for integration with future eHealth systems, standardised data collection, greater data flow, data stewardship and investment in analytical capacity.”
“The proposals include GPs directly employed by the HSE, because not every GP wants to be a small business owner; a new DEIS-for-GPs scheme, in recognition of the higher health needs of patients in deprived areas; implementing the programme for Government commitment to expand GP care to under-12s; and, crucially, setting out a clear timeline for delivering universal GP care to everybody by 2030. These proposals are not radical; they are the European norm. Will the Government do more than talk about reform of GP services? Will it deliver it, and will it start by supporting our 20-point plan to transform GP services?”
“Successive Fianna Fáil and Fine Gael Governments have been talking about reforming GP services for years but have failed to deliver. The Government's strategic review of GP services, first promised in 2019, still has not been completed. During that time GP fees have risen to as high as €90 in some areas, and that is just to get in the door. Price, however, is not the only barrier. An increasing number of GP practices are oversubscribed and understaffed. We know there are no quick fixes. That is why the Social Democrats are proposing a comprehensive 20-point plan, which will be debated in the Dáil tomorrow.”
“Three years after the hospital opened, that is an utter disgrace. The HSE promised to open 18 of those beds last year but just two opened - another broken promise. On top of that, unforgivably, there are 28 vacancies in the hospital. Will the Government immediately fill these vacancies and open the overdue mental health beds?”