I also welcome the Ceann Comhairle's statement on the voting controversy in the House last Thursday. I, too, regard it as a most serious matter that deserves to be addressed urgently and resolved.

The Government recently announced plans to extend free GP care to children aged seven and eight years. As the Taoiseach will know, the previous Government provided GP care for all children up to the age of six years and for those over the age of 70. The move to provide it for the under-eights is a slow realisation of the pledge made by the previous Government to provide free GP care for all. It suggests the current Fine Gael-led Government is not convinced by the arguments made in the Sláintecare report for a single tier public healthcare system, rather than the current two tier one. It is also another example of the poor use of public finances. The Government will have to negotiate with the GPs again to agree a new contract to cover the under-eights. What then? If free GP care is expanded further to the under-tens or the under-12s, it will require new contracts. How many contracts will it take before the Government reaches the objective of providing free GP care for all? How much more time and money will it take to go through the various rounds of negotiations? Every time there is a new contract, the public finances lose leverage over the whole project and the next phase becomes more expensive. It would be much better value for the money to move directly to providing free GP care for all those above the age of 18 years, which is what we had envisaged, rather than take a series of incremental steps. We know from medical statistics that older people and the under-sixes use GP care services more than most and they already have access to free GP care. By and large, people with major medical needs have a medical card.

There is simply less medical need among the population of older children, teenagers and working adults. It does not require an incremental approach. It should be done as one negotiation. It is inefficient to drag this process out and it represents a failure of Government to deliver. We were able to negotiate care for children under the age of six in the worst of times but no progress has been made on this critical issue over the past three years. I have two questions. Will the Government agree to extend free GP care to everyone or at least to those under 18, rather than the policy announced by the Taoiseach of simply adding another two years to include those under eight? If not, will the Government at least produce a cost-benefit analysis of both courses of action?

I thank the Deputy. I am very committed, as is this Government, to moving towards universal healthcare in this country, but I also know the steps that have to be taken and how difficult it is to achieve that. Part of universal healthcare and the Sláintecare vision is ensuring that everyone in the State has access to healthcare that is either free at the point of use or provided at a very low and highly subsidised cost. My party, in coalition with Deputy Howlin's party, made a very positive step in that direction even before Sláintecare by extending free GP care to all children under six and all adults over 70. I worked closely with the Deputy and the then Minister of State, Deputy Kathleen Lynch, to deliver that during the last Government.

This Government, comprising Fine Gael, the Independent Alliance and Independents, has built on that still further. We extended the medical card without any means test to all children with profound disabilities, 40,000 of them. We also extended free GP care to anyone in receipt of the carer's allowance and carer's benefit.

Hear, hear.

Last year, we increased the income limit for low-income working families by 10% so that more of them would qualify for free GP care. The budget announced a few weeks ago included changes to income limits to extend the full medical card to approximately another 50,000 people aged over 70.

Hear, hear.

This Government has very much built on the progress Fine Gael and the Labour Party made together. We intend to build on it still further. The next step, which will be taken later next year, is to extend free GP care to children aged seven and eight. The year after that, it will be extended to children aged nine and ten, and the year after that to those aged 11 and 12. That does not preclude us from also doing other things by changing income limits, but that is our current plan.

The incremental approach is right. When I was introducing free GP care for children aged under six, I remember seeing the research from health experts and all of the people who go on the radio and tell us about health expertise. They said there would not be a big increase in attendance of GP services by those under six. They were wrong because there was. We know that now. When free GP care for children aged under six was introduced there was a big increase in attendance at GP surgeries, particularly at out-of-hours services. I do not want to do this too quickly and overwhelm the capacity of general practice to deliver. The NHS is a pretty good health system, but people using it have to go on waiting lists to see their GPs. A two-week or three-week wait to see a GP is normal in the NHS. I know that happens in Ireland, but it is pretty uncommon. I do not want us to overwhelm the capacity of primary care and general practice to deliver. That is why I think it is better to do this in an incremental manner, and that is what we have decided to do.

Legislation is required to deliver on the commitments. It is relatively straightforward. The Minister for Health is working on it. We think we can have that through the Houses before Christmas, or if not, in the early part of next year. It requires consultation with GPs on fees. However, because we have agreed with the GPs that this will not be compulsory and they do not have to provide the service, it does not require negotiation to be concluded. We just need to consult GPs on fees. They can then decide whether they want to opt in to providing care to children aged seven and eight.

There will be another budget now and we will try to get it all sorted.

If the Minister of State reflected on what the Taoiseach has just said, he would be shocked. He basically said that he does not want GPs' surgeries to be overwhelmed so he will put a brake on them, namely, cost. The Government will continue to charge and that will be the brake. If people can afford to go, off they will go. The Government will monitor and reduce the numbers by keeping a charging mechanism in place. That is not the universalism approach we have been advocating and which we advocated in government.

The changes the Taoiseach has outlined move against the principles of universalism - a universal health system available on the basis of the need, not ability to pay. Having been in the Department of Public Expenditure and Reform for five years, it makes no sense to me to negotiate incremental contracts. The closer we get to getting the final tranche done, the more it will cost. That has been the experience of any incremental contract system. It is much better to do it in one fell swoop and agree a contract for all the under 18s and then the next tranche up to full universal coverage. That is the approach we worked on together in government but it has been abandoned since the Labour Party left government. It is not acceptable to propose reducing pressure on GP surgeries by continuing with a charging mechanism that allows those with the money to have access to have their children treated, but those without the money to have to wait.

I do not think that is quite the case. We agreed in government that we would first provide free GP care to those aged under six and over 70 regardless of their incomes. The next step we had agreed - money was provided in the Deputy's final budget - was to go from age six to 12. We were, therefore, pursuing an incremental approach.

What happened?

This Government has done something slightly different. We decided to increase the income limits by 10% for low-income families. Some 40,000 children with profound disabilities now get full medical cards as of right regardless of their parents' income. We have decided to increase the income limits for the over 70s in the budget just introduced. We also decided to give people on carer's allowance and carer's benefit access to free GP care because carers also need to have their health looked after. It is still an incremental approach by the previous Government and by this Government, but perhaps a different approach to that incrementalism.

I will answer the Deputy's question very frankly and I say this as a former GP, former Minister for Health and Taoiseach. If we provided free GP care for everyone tomorrow, next year, the following year or even the year after that, we would overwhelm primary care and general practice in Ireland.

People cannot see their doctor if they cannot afford to.

We know from the experience with those aged under six that there is a big increase in attendances. I do not want us to have primary care systems such as those in the NHS-----

Sick people have to stay away because they cannot afford to pay.

-----where people have to wait for weeks and weeks to see a GP. That is not the norm in Ireland at the moment and I do not want to see general practice and primary care overwhelmed. I do not want a situation where people cannot get a GP - I know that is an issue for some people-----

It is for a lot of people.

-----but most people still can - and where people have to wait for two or three weeks as the norm to see the GP, as is the case in England. We do not want that to happen here. It is better done incrementally in co-operation with the GPs and the IMO representatives.