The headline health measure in the budget is the proposed extension of free GP care to all children under 12 years.
The measure will benefit 200,000 young people, cost about €40 million and is scheduled to begin at the end of next year – long after a new Government is installed.
The initiative is a logical follow-on from the introduction of free GP care for under-6s this year and is being introduced for the same nakedly political reasons. That doesn’t make it a bad thing – though not in the eyes of doctors - as there are sound public health reasons for the early identification of problems in developing children.
While an extension of the scheme was always intended, it is being fast-tracked “subject to negotiations with the Irish Medical Organisation” in the light of the successful introduction of the first phase of the scheme.
The under-6s scheme cost €67 million under the deal hammered out with the IMO, well over the €37 million originally anticipated. It’s early days yet, but the scheme has worked well so far, with nothing like the surge in GP visits by young children and their parents that was predicted in the profession.
It’s likely the extension of the scheme will also cost over the odds, given the IMO is expecting the overall GP contract will be renegotiated before, not after, this happens. It warned nothing can happen before a new GP contract is negotiated but, as was the case this year, money will ultimately do the talking.
The staunch opposition of the other doctors’ organisation, the National Association of GPs, can be counted upon, especially if it remains outside the negotiating tent. There will also be knock-on pressures on hospitals in the form of more referrals and diagnostics.
While doctors reacted angrily to the proposal, Mr Varadkar went some way toward mollifying the IMO on Tuesay night by clarifying that the extension of free GP care will be dealt with as part of the talks on the overall GP contract, and not separate from it.
He also made a fair point by referring back to the “wall of scepticism” that the under-6s proposal met when it was announced on budget day last year, and yet this has come to pass without much fuss in the end.
The pressures on the health budget are enormous - they include rising demand, demographics and the ageing of society, pay restitution and the enormous cost of new drugs - and there is something about the miracle of the loaves and the fishes about the annual budget presentation of the figures.
The first issue this time around is the discrepancy between the €880 million in extra money the Minister was claiming, and the fact that the overall budget he announced was less than €100 million greater than the one he unveiled a year ago. This, seemingly, is down to accounting issues but it provoked much head-scratching among journalists attending the Minister's briefing while Fianna Fáil, off-camera, cried foul.
But even taking the Government at its word, it’s hard to see how the extra money can be made to go around. At least €600 million will be needed to cover the cost of this year’s overspending, €100 million for pay awards, €40 million for the extension of GP care and millions more for crisis measure to alleviate overcrowding and long waiting lists in hospitals.
Some of this could have been funded by the tax of sugar-sweetened drinks sought once again by Mr Varadkar or an increase in alcohol duties, but neither of these materialised in the budget.