Eilish O'Regan: 'Budget package will woo the family vote with free GP visits for 70,000 more children'
The proposal to extend free GP care to under-eights would benefit around 70,000 more children.
It's a more modest measure than the introduction of free visits for the under-sixes in mid 2015 which covered 440,000 children.
For this reason it may also get a better reception from overwhelmed GPs.
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The give-away ingredients of the Budget will also have to carry Fine Gael into next year's general election.
So there is something of a relief that it is moving in practical steps and away from the shiny gimmickry of its term in the 2011-2016 government.
Although the extension is expected to be announced in next month's Budget it will be well into next year before it is in place and it will require legislation as well as an agreement on fees with GPs.
GPs will be allowed to opt in or out of the scheme.
Although it will be welcomed by families, how realistic is it, given the evidence that so many GPs are currently inundated with very ill older patients and having to close practices to new patients?
The hope is that come this time next year general practice will be in a more resilient state as the payments under the €210m deal agreed this year to reverse recession cuts in fees filter through. But it is unclear how long the recovery will take.
Some of the biggest impacts of the under-sixes deal have been on out-of-hours GP services which should be just for emergencies. This is also a likely pattern for the under-eights.
But these co-ops currently can find it difficult getting locums.
In March this year, around two million people were covered by either a medical card or GP visit card - some 42pc of the population. So there is still a long way to go to free GP care for all.
The Budget is also expected to announce free dental care for the under-sixes.
The exact package has yet to be revealed but it will have to include examinations, assessments, some treatments as well as a heavy emphasis on prevention of tooth decay.
The plan is to shift more care to private dentists.
It is part of a wider dental policy which would replace the existing Public Dental Service school programme which covers children under 16.
This offers emergency treatment to all children and routine dental exams for school children.
It will also be later in 2020 before this is on offer to children and there will need to be agreement on fees with dentists. It takes three times longer to provide dental care to a child than an adult.
Dentists could also prove to be a tougher group to negotiate with than doctors.
The Irish Dental Association is particularly aggrieved that around €1bn cuts in State funding for dental care have been removed in the last decade.
It is also angry that it was not consulted in the drawing up of the new dental plan.
The other Budget proposal - revealed in the Irish Independent today - is to increase funding for HSE homecare.
In 2018, the total budget for the service was €416.8m, providing more than 17.5 million homecare hours.
This year another €30m was added to home support funding for 18.2 million hours.
But the demands are outstripping the increase with around 7,000 mostly older people on a waiting list for the service.
With the promised statutory homecare scheme still some time away the hope is that next year, the geographical variations in service highlighted in a recent ESRI report should also be examined in the share-out of funding.
Counties such as Sligo, Leitrim, Kerry, Louth, Meath and Donegal have consistently higher per capita homecare hours over many years, according to the ESRI.
Some counties, including Dublin north, Louth, Meath, Clare and Laois saw increases in hours relative to the older population between 2012 to 2015.
Over the same years counties including Longford, Westmeath, Waterford and Cork suffered reductions in homecare hours relative to their population. Postcode lotteries of this kind should be ironed out by the time any sweeteners announced on Budget day are distributed.