Deputy Stanley is on his feet. Taoiseach, the time is up.

I want to raise the situation regarding the absence of health cover for a large section of the population. Many middle- and low-income households have either very limited health cover or none at all. Forty-five per cent of the population have some kind of private health insurance. Most people who have such insurance have very limited, partial and restricted cover. A total of 42% have medical cards that provide either full medical cover or just GP care. This breaks down to roughly 30% having full cover and 12% having GP care cover. What these figures show is that 57% of the population have very limited cover. Worst of all, 13% to 14% have absolutely no health cover whatsoever.

These workers and families are typically on low to middle incomes but they live in one of the richest countries in the world. That is a scandal. The facts are that the income thresholds relating to entitlement to a full medical card have not increased in over two decades. The Taoiseach was Minister for Health at the time. The thresholds are of the 1980s variety. The latest figures from this year show that a single person has to be on an income of less than €184 a week in order to qualify. The threshold for a couple to qualify for a full medical card is €266.50 per week. If they have two children, the threshold is €345 per week. For the GP-only card, the threshold is €373 a week for a single adult and €607 - which roughly equates to €30,000 per year - for a couple. This means that many households which cannot afford it have no access to even basic healthcare or GP care. In turn, this gives rise to medical neglect.

I fully support Sláintecare. We are making some progress on that, but it is not happening quickly enough. Ten years were allocated in respect of the implementation of Sláintecare and universal healthcare. Those ten years will run out in 17 months' time. The process relating to full implementation has to be stepped up.

The position relating to discretionary medical cards needs to be examined and improved. As a start, we need to ensure that cancer patients have full medical card cover. On 6 March 2025, the Minister for Health, who is sitting beside the Taoiseach, in reply to a parliamentary question I tabled, stated:

I can assure the Deputy that my Department keeps medical card issues under review ... Over the course of 2025, we will review the existing eligibility framework to clearly assess what is working well ... This is an important step towards delivering on universal healthcare

I agree with her on that, but it is 105 years since independence and the establishment of this State. Budget 2027 will be introduced in 12 weeks' time. I accept that everything cannot be done at once, but will the Government ensure, as the next step towards implementing Sláintecare, that income thresholds will be increased in order to provide medical card cover to the workers and families who do not have any at present? Will it also ensure, very importantly, that cancer patients have full medical card cover? I welcome the fact that the number of training places for GPs has been increased, but will the Government expand the process in this regard further and get the HSE to directly employ GPs in to fill the gap in rural and urban areas where people do not have access to GPs at present?

I thank Deputy Stanley for raising this issue. He mentioned that Ireland is well over 100 years in existence as an independent State. There is a great book by Mark Henry, In Fact: An Optimist’s Guide to Ireland at 100. It contains a great chapter on health that I invite Deputy Stanley to read. If he looks at what people were dying of in 1922 and 1923 and the average lifespan at that time and the position today, he will see that there is no comparison. There has been an incredible improvement in the average lifespan. Ultimately, that has to be the measurement of any health service and of a broader societal approach to health and well-being. With a life expectancy of 83 years in 2024, Ireland ranked sixth highest among EU member states. I was Minister for health from 2000 to 2004. We were nowhere near this level of life expectancy at that time. The reason was that we did not have any national strategies on the key killer diseases, namely cancer and cardiovascular disease. We developed national strategies from the late 1990s onwards for cancer and cardiovascular disease. These had very dramatic beneficial impacts.

Those strategies were followed by substantial investment as well. Our mortality rate fell by 16.1% over the decade from 2015 to 2024. Our mortality rate for all circulatory system diseases fell by 28%, with the rate for heart disease and stroke falling by 34% and 42%, respectively. The mortality rate for all cancers dropped by 13.7%, with cancer of the trachea, bronchus and lung and breast cancer dropping by 19.3% and 11.7%, respectively. The mortality rate for respiratory diseases is down by 23%. I just need to make those general points. We are making progress. The investment has been huge. We have invested exponentially now in our health services.

In respect of GP and primary care, we have now had the biggest expansion of access to free GP care in the history of the State. If we take medical cards and GP visit cards, about 2.3 million people are eligible for free GP care, including those with medical cards and GP visit cards. We have reduced the threshold for the drug payment scheme to €80 per month. We did this progressively over the past number of years. We have funded diagnostic scans now for patients. We have introduced free contraception for women up to the age of 35. We are publicly funding assisted human reproduction, including IVF, and free HRT.

I thank the Taoiseach.

We have also developed a much-needed revolution in women’s healthcare in terms of see-and-treat gynaecology clinics and-----

I thank the Taoiseach. You will be coming back in. I call Deputy Stanley.

-----fertility hubs and specialist menopause services. All that helps to gain greater access for patients.

I thank the Taoiseach. The time is up. I call Deputy Stanley.

That is all fair and good, and I acknowledge there has been progress. Of course, there has been progress in 105 years. There has been progress in my lifetime, which is a bit less than 105 years.

We can see from the Deputy's demeanour that he is doing very well.

I am hoping to get a bit longer than 83 years out of it.

The fundamental question here concerns people who do not have health cover. Progress is being made towards implementing Sláintecare, and I acknowledge, in particular, the stand taken by the Minister in relation to the contracts for consultants. If they are paid to work for the full week by the State, then they cannot do private work during that time. A plumber working for the Office of Public Work, OPW, cannot be off doing nixers during the day for somebody else. We support her in doing that.

Universal healthcare is where we have to get to. We are out of step with other states. The Taoiseach will have to admit, and he has not addressed this, that since he was the Minister for Health, those thresholds have not increased, and I acknowledge all the progress that has been made, although we have a distance to go yet. It is €184 for a single person, €266.50 for a couple and €345.50 per week for a family of four.

I thank the Deputy. The Taoiseach has the figures. I call the Taoiseach to respond now, please.

I again thank the Deputy for raising this issue. The biggest movement in the past couple of years has been the GP access card, the GP visit card, more than the medical card. I acknowledge that point. We have, however, reduced the drug threshold payment as well. We are also building up the public health system as per Sláintecare and Government decisions-----

The Taoiseach himself-----

-----which I think are, in many respects, extremely important in terms of the diagnostic hubs and the community-based model that has been evolving over the past number of years. It actually gives people very ready access to diagnostics and treatments in terms of not having to access the acute hospital system all the time.

On growing college and training places, which the Deputy referenced earlier, as he knows, there was a big investment in 2026 enabling higher education institutes to deliver over 1,100 new healthcare course places each year over the next three years.

I thank the Taoiseach.

We have had a particularly significant investment in more GP places in our colleges and clinical placements thereafter.

I thank the Taoiseach. I appreciate that there is a lot of information.