asked the Minister for Health if he received a submission from the National Council for the Aged on the effects of health expenditure cuts on the elderly; if so, the action he took or proposes to take; and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - National Council for Aged.
6.
I have received the submission in question and am, naturally, anxious to ensure that the elderly should not experience avoidable hardship in the delivery of services.
The ad hoc dental and optical schemes, using private practitioners, were resumed in the current year in all health boards except the Southern Health Board. That board have not resumed the ad hoc dental scheme but the elderly are regarded as a priority group and are treated as such by the board's own dental staff.
With regard to transport services, the Western Health Board have been obliged to restrict this service. However, the cost of transport to clinics is subsidised or met in full in all cases of hardship. All doctors in the region have been advised of the new arrangements to ensure that all appropriate cases are identified.
Health boards have funds at their disposal to supply items, which are no longer available free to medical card holders, to patients who would otherwise experience hardship. The distance of a patient from the nearest supplier can be taken into account in this regard. Bandages and dressings applied by public health nurses are, in fact, generally supplied free of charge to medical card holders. Consequently, I am satisfied that the points made by the National Council for the Aged have been met.
Does the Minister accept that there is a waiting list in respect of elderly persons who need medicines which are no longer available on the general medical services list? In some cases it is just not possible for a health board to administer a scheme which will supply the necessary drugs when needed.
I have been surprised in the last six to eight months at the very few complaints which my Department and the health boards have received. I could count on the fingers of my hand the number of representations from Deputies relating to the care of the elderly and the occurrence of hardship cases. In relation to the withdrawal of various items in mid-1982, the total number of complaints received by the then Minister would be approximately 150. Out of these, about 120 were immediately met by the health boards.
That is some Uturn since last year.
I am satisfied that the care of the elderly by our health boards is probably the best in Europe. I made a recent survey and am quite satisfied that it is exceptionally good.
Would the Minister accept that the National Council for the Aged recommend general medical service cards for all over 75 years of age? Has he any proposal to implement that recommendation?
I am aware of that, but do not see a justification for it. Medical cards generally and the general medical services scheme should be based on income eligibility. It would be quite wrong if somebody with a substantial income should on reaching 75 years of age automatically receive a medical card, just as I held it wrong that persons over 65 years should automatically receive pensions.
Would the Minister accept that those over 75 years of age are high risk patients, irrespective of income and should be subject to the same guidelines as apply for those in the younger age groups? Would he not consider that a case could be made at least for raising those guidelines to include the over 75's?
I would not accept that on the grounds of utilisation of scarce health resources. It would be quite wrong that somebody with a substantial income at age 70 or 75 should get free general medical services. One could argue that case in relation to many other groups in the community on either age or sociological grounds. I do not see a logic in suggesting that persons aged 75 and over should automatically get the medical card, irrespective of income.
In other words, the Minister considers that £77 for an old aged pensioner and his wife is a sufficient income.
I am never satisfied in relation to income eligibility criteria but do not believe in their abolition. The Deputy is proposing a measure which I would estimate to cost £4 million. I could spend that amount on many other areas of health with far greater effect. Surely the Deputy is not suggesting that somebody with an income of £10,000 a year——
He is not.
I am thinking of an old aged pensioner and his wife living on £80 a week.
The position there is quite simple: 40 per cent of our population have free general medical services.
So much for a socialist Minister for Health. Why was the ad hoc scheme not resumed by the Southern Health Board? Furthermore, would the Minister not accept that representations regarding hardship cases among the elderly are not normally made by Deputies to the Minister in this House? They are made to their respective health boards. That is why the Minister can count on the fingers of one hand the number of complaints which he has received.
That appears to be an argument rather than a question.
It is a question.
I assure the Deputy that the community care divisions of the various health boards give without question every possible assistance to the elderly in their areas. The Deputy is well aware of that in relation both to the Southern Health Board and other health boards. There have been particular difficulties in resuming the ad hoc dental and optical schemes in the Southern Health Board area——
Why?
Because the health board have not succeeded in setting up a structure and I am pressurising on that aspect.
Is it not because of the shortage of money?
It is not a question of money.
Of course it is.
It is a question of organisation.