It would, but for the fact that during Question Time today I asked the Minister if I heard him correctly when he mentioned that in the south eastern area three senior officials on the Cork board had been transferred to the new health board and the Minister said that was correct. The Minister may not be aware that throughout the country a special effort appears to have been made to ensure that the staff officers, to whom he has referred, do not get appointments on the new boards. In fact, they were not considered as eligible to apply until I asked the Minister in the House if he would do something about the matter. As a result of his representations, the staff officers were informed that if they wished to apply they would be considered but this was not done until after an interview was held. In a number of cases the staff officers did not apply and I do not blame them. It is obvious they were being told they could apply if they wished but they had very little chance of getting the appointments.
How can the Minister now say that these people will be in a position to advise the CEOs when, in fact, most of them have terminated—or are about to terminate—their employment under health and are going back to local authorities as staff officers on roads, on housing or in some other section? I know a number of such officers who have spent most of their public life dealing with health matters but a deliberate effort has been made to ensure they do not continue with this work.
In view of this, does the Minister wonder that some of us are suspicious about what will happen? Those of us in public life from time to time have received representations from people who considered they were entitled to medical cards. As holders of the cards they were entitled, under the Health Act, to certain services and if they did not get those services we could discuss the case with the staff officers. In no case could we intimidate the staff officer concerned, even if we wished to do so, because the officer was doing his job efficiently. The Minister can understand the situation that exists now. Prior to this we could talk to the staff officers employed in the local authority, of which we might have been members or have been associated with the authority. Now we must talk with somebody who does not know, or care, who we are.
The Minister has stated that the new arrangement will be an improvement. I can see nothing but chaos arising as a result of this gesture. Instead of the regulations being laid down by the Department so that nobody could accuse any person of giving medical cards to those not in need, or debarring those who were entitled, we now have a situation whereby the CEO will be entitled to decide who should have a medical card. This is the source of all the trouble.
It is not merely a matter of a regulation being introduced every year or every two years. We are discussing a new Health Act. It is framed in such a way that it will come into operation in stages during the next 15 or 20 years. We are discussing a measure that will bind not only those people we know but will affect their children and grandchildren. This is because some people have not taken the trouble to find out the best method; instead, they took the easy way out. In this case I accuse the Minister of allowing someone to sell him a story, which he accepted apparently without question, that the proper method to deal with the problem was to hand it over to someone else instead of doing the job himself. I am deeply disappointed the Minister has not carried out what he has said he would do. I understood when the Minister gave his word to do something he would keep his word. I cannot understand why he has changed his mind in this matter or who has twisted his arm for the purpose of ensuring that the matter would be dealt with in the way now suggested.
There is another matter to which I should like to refer, namely, how means are to be calculated. Maybe I do not understand it fully. Like every other piece of legislation this particular piece of legislation is worded in such a way that it is extremely difficult for some of us to understand what exactly is meant. The suggestion here is that, instead of calculating yearly means by the method used to calculate them up to now, a new system of determining income is to be introduced. Section (2) (b) provides:
"Income" for the purposes of subsection (1) (b) shall mean the income of the preceding year ended on the 5th April and shall include all income which the person may have received for that year from all sources.
During the Seanad debate a Labour Senator asked the Minister if, in fact, income tax was being included or excluded. I am sorry; I should have said overtime. He asked if overtime was being included or excluded and the Minister very explicitly stated that overtime was being excluded. Would the Minister care, when he is replying, to explain what he means by saying:
"Income" for the purposes of subsection (1) (b) shall mean the income of the preceding year ended on the 5th April and shall include all income which the person may have received for that year from all sources.
I caught the Minister's comment—self-employed persons. There are, of course, self-employed persons who do other work and, as the Minister knows, the income tax authorities will collect whatever should be collected as a result of any work done, including overtime earnings. It is very difficult to define the term "self-employed" and the Minister and his officials must be aware of this because, instead of saying self-employed persons who qualify under a certain heading, they have put in this section out of the income tax code. Am I to take it that what the Minister is saying is that self-employed persons who may be claiming medical attention under this particular section will need to produce a certificate of tax free allowance before they can claim? Is that so or is it not? Is the Minister saying that the only certificate which will be accepted will be the one accepted by the income tax authorities, not the visit from the home assistance officer or the superintending assistance officer, or anyone else? It is provided here in subsection (c) of section 2:
In determining the amount of income for the purposes of subsection (1) (b)—
(i) regard shall be had to the amount of any income which would be chargeable to income tax under Schedule D or Schedule E as it would be determined for the purposes of an appropriate income tax assessment based on the income of the year.
(ii) the amount of any income from which Irish income tax would be deducted at source shall be based on the gross amount of the income receivable during the year.
(iii) the income from an employment shall be taken as the excess of the total emoluments for the year over expenses properly deductible for the purposes of Schedule E.
The Minister was being a bit naïve when he said that these are self-employed because the reference even in his own brief is to people who are, in fact, employed and who, as well as being self-employed, may do a different job from time to time. It will be "God help the poor" if the Health Act, the operation of which we have been watching for the past 12 months, the Health Act which will, we expect, be in operation for the next 15 or 20 years, it will be "God help the poor" if that Act is continued in the way apparently visualised in this particular section. I think the Minister has deliberately or otherwise—I would hope it was otherwise—created a situation which, instead of improving the position from the point of view of those seeking medical services, will in fact make it a thousand times worse. We know that the medical profession is in the main constituted of very humane persons, very dedicated persons who go out of their way to ensure that health services are given to those who need them. We also know, however, that there are people in the medical profession who believe that the primary object is to make money. All of us from time to time—I am sure no one more than the Minister—have had complaints from persons who tell us that the first thing the doctor did on coming into the house was to ask who owned the car outside the door, the car the breadwinner was using to get to work, or commented on the fact that there was a television set in the house and, because there was, the people living in the house were not entitled to a medical card. By a strange coincidence, in cases like that a medical card is very often withdrawn until a row is kicked up and the card is returned. We were hoping that the Minister in his introduction of a list of incomes for a medical card would do away with that kind of thing. In fact it now appears as if the situation will be worse than it was before.
The Minister referred the other day to a free choice of doctor coming into operation on 1st April, as well as certain other things. I do not know whether or not it is simply a question of the Department trying to fit things in in a certain way so that there will not be too much trouble for them or whether they are really interested in having a decent health service. It is my opinion that the former is the case. Like other speakers here, I am a member of a new health board. So far that health board is no better or no worse than any of the others. So far it appears as if it will not do very much for the health of those who really need help. I have had experience of individuals who felt they were entitled to certain types of treatment. I had one particular experience in which the husband was earning the princely sum of £21 per week, including overtime. There were three children, one of whom was an invalid. The mother had a nervous breakdown. There was a history of unemployment in the family before that. The mother found it absolutely impossible to get a medical card. So did her husband. They found it impossible to get surgical boots for the invalid child. They found it impossible to get drugs. Everything seemed to go wrong. I kept assuring them when this new list was introduced they were the people who would of necessity come under the new scheme and there would be no doubt as to their entitlement or, as the Minister likes to call it, their eligibility to this card. Now we find that the Minister has no intention whatever of trying to draw up a list. He just dumps it back again —Paddy-go-easy; what was good enough for those before me is good enough for me—and he will deal with it in the same way.
The right of Members of this House to seek information from health boards has been challenged by some of the people running the boards and the Minister has been very definite that information which is available should be given to Members of this House and that Members of this House are entitled to information. Would the Minister state what he considers to be the right of a Member of this House, or of a county councillor who is not a member of a health board or, indeed, a member of a health board to comment, advise or make representations on the issue of medical cards? This is an issue which will become very live after 1st October and most of us would like to know where exactly we stand on this. There is no point in burying our heads in the sand and saying it is bound to turn out all right on the day. Many a thing has gone wrong because that attitude was adopted. There is the suggestion that this is something which is only a matter of form and the Minister was very anxious to ensure speakers would not go outside the terms of reference of his regulations. If this particular regulation were not issued now in the dying days of this session—perhaps of this Dáil, as I believe it is—it would be debated for several weeks. I believe a number of people who would have taken part in this discussion are not doing so because they feel there are other matters that must be debated before the Summer Recess.
I should like to know from the Minister what are the opinions in his own party, not the opinions of those who will vote with him if a vote is challenged but the opinions of the backbenchers of his own party who do not appear to have been allowed to say a word about this Bill. We can always gauge the support a particular Government measure has in the House by the number of backbenchers or front-benchers who come in on the Government side to support it. Not many of them are rushing to speak in favour of the motion now before the House. The Minister has not got a word of support or encouragement from any of the Fianna Fáil Members in the House. Does he not think this strange? Is it not true that they feel as we do, that this is not the way to do things, that the Minister is taking short cuts which he should not take and that they are not prepared to stand up and be counted.
There are many aspects of this matter to which I should like to refer. Unfortunately, the section has been put into a sort of straitjacket so that the debate cannot be widened too much. We must keep within the rules of order. It is very difficult when commenting on something like this to keep within these limits in respect of something that has so many side effects which, in my opinion, could and should be debated. Unfortunately, we cannot do that; we must stick to what is on the Order Paper. Therefore, I shall conclude by saying again to the Minister that a mistake has been made. He should reconsider this question of issuing the instructions as to who is or is not eligible for a medical card in black and white so that everybody will know without having to ask anybody else whether he or she is entitled to a medical card. Being a highly intelligent man with a sense of responsibility, as his record shows, the Minister should not try to bring in something such as he brought in here last week and think it would go through without comment or think it would solve the problems of medical cards. I believe the problems will only begin when this news breaks to the country that the long-promised and often-promised list will not be published.
I appeal to the Minister to reconsider this matter and not leave it to eight appointed people who are not approachable and who cannot be held answerable even in their own health committees because I am sure we shall be told that this is a matter which is reserved for the CEOs. At least the Minister can be held to be answerable in this House. The decision should be made to publish the list as promised and satisfy those who at present feel that they are not being treated fairly in regard to the issue of medical cards.