P. J. Sheehan
Question:10 Mr. Sheehan asked the Minister for Health and Children if all people over 70 years of age will have medical cards from 1 July 2001. [19370/01]
Other Questions. - Medical Cards.
Ivor Callely
Question:40 Mr. Callely asked the Minister for Health and Children the progress made in issuing medical cards to people over 70 years of age; and if he will make a statement on the matter. [19114/01]
Marian McGennis
Question:163 Ms M. McGennis asked the Minister for Health and Children the action which he intends to take regarding the refusal by some doctors to sign medical card application forms for patients over 70 years of age. [19527/01]
I propose to take Questions Nos. 10, 40 and 163 together.
As Questions Nos. 10 and 40 are both oral questions, not more than 12 minutes is allotted.
The extension of the medical card scheme to give automatic eligibility to persons aged 70 and over was announced in the budget and legislative effect was subsequently given to this decision by the Oireachtas in the Health (Miscellaneous Provisions) Act, 2001.
As I said in reply to an earlier Priority Question, negotiations have taken place with the Irish Medical Organisation with a view to resolving this issue and, while some progress was made, these negotiations concluded earlier this morning without achieving a resolution. Efforts will continue to be made to resolve the issue and against this background it would not be appropriate to comment further at this stage on the detail of the negotiations. In addition, an agreement must be concluded with the Irish Pharmaceutical Union and discussions with this organisation are in hand.
I propose to sign the commencement order under the Health (Miscellaneous Provisions) Act to commence the relevant provision entitling those aged 70 and over to automatic eligibility for a medical card because of the other benefits which will accrue to them, and contingency arrangements have been made with health boards to issue medical cards. It will then be a matter for the IMO and for individual general practitioners to decide their position but I wish to make clear that the Government remains committed to this important social policy development. When those negotiations are successfully completed, I would expect all general practitioners to co-operate with all aspects of the new arrangements.
Is the Minister not ashamed and annoyed by the fact that this measure was announced last December but has not yet been put into effect? It was heralded as a major breakthrough and since then it has been clearly indicated that doctors are not happy with the way in which the matter was handled. Is the Minister aware of the fact that today in County Monaghan, an old age pensioner applied for a medical card, in his own right, but the doctor refused to sign it? This man is entitled to a medical card irrespective of whether he is over 70 years of age. Because he is over 70, however, and is classified under the new arrangement the Minister introduced last December, he has been refused the right even to have his application considered. This is a very serious matter and the facts speak for themselves.
I commented on this earlier. I made the point that I intend to sign the commencement order which, from 1 July, will entitle all people over 70 years of age to the benefits that a medical card bestows. I would be happier if I were in a position to announce a resolution to the issues that have been raised. Those issues are fundamentally about the level of payments to general practitioners. We have made a significant offer on that front and both parties are in contact with each other. I am hopeful that we can resolve the matter but, if not, contingency plans are in place.
Will the Minister tell the House why he found it necessary to take the unusual step of incorporating in legislation the provision of medical cards to people over 70? The Health (Miscellaneous Provisions) Bill was resubmitted on Committee Stage to facilitate a technical amendment, but why did the Minister do that? As these medical cards are to be made available under the law of the land, will the Minister confirm that if he signs the order and general practitioners refuse to provide the service, those over 70 will have the right to sue? Who can they sue?
Would the Minister agree the real problem is that he has tinkered with the system and, as a result, a single person on £101 per week does not qualify for a medical card? Is it not time that we comprehensively reformed the medical card system by making the necessary investment so that poor people, children and the elderly have free access to general practitioners?
The amendment I tabled to the Health (Miscellaneous Provisions) Bill, which was agreed unanimously by the House, was done strictly on legal advice. The advice was that if we did not insert that measure, in future the State or the Government of the day could potentially be vulnerable to a legal challenge over the provision of services under the GMS to people aged over 70.
I have no difficulty about an overall review of reform. Our forthcoming health strategy will provide a particular perspective on the basis of that reform.
Like the Minister's election promises.
We have already committed ourselves to a fundamental review of general practice with the IMO and the Irish College of General Practitioners. One cannot reform the GMS on its own without a fundamental reform and investment in general practice and primary care.
How can the Minister justify not giving a medical card to someone on £101?
I will deal with that later.
Would the Minister not accept that this is a problem solely of the Government's making? Had the Government chosen, for example, to increase income limits for medical cards, doctors would not have had a leg to stand on. In terms of this decision, however, which went as far as requiring legislative changes, the Minister is now open to a range of grievances from general practitioners, some of which go back years. The Minister is in a very awkward position since he made the running on this provision and is unable to deliver on it by 1 July. Surely the Minister is aware that he had contractual obligations with the general practitioners? It was both foolish and misleading of the Government to make this announcement without regard to those obligations. The Minister should take the initiative to get out of this mess by re-negotiating the contract with general practitioners. This would ensure that we have a fair and free system of general practice care which doctors can deliver on the basis of being compensated. That is not to say that we are taking the professionals' side. We have argued for, and the Minister has preached about, partnership but this example is the complete opposite of partnership. It is sledge-hammer negotiation.
Not alone has the Deputy's minute concluded but she is making a statement, not putting a question. Two other Deputies are offering.
One can approach the extension of eligibility under the GMS in a number of ways. One can do so on grounds of basic income eligibility, which crosses all age groups but makes no reference to medical need which is often a critical factor in the need to have a medical card. A healthy 35-year-old, irrespective of income, may not need a medical card as much as a 74-year-old person, due to obvious circumstances. Many demands have been made in this House that people with specific diseases or medical conditions should get medical cards automatically.
Why not? The Minister has the money.
That issue is independent of income guidelines, as well.
Yes.
We cannot do everything.
The Minister could do much more than he is doing.
We have done a fair bit.
At the moment, the Minister is doing nothing.
With respect, we have already delivered significant extra investment to general practice. As regards Deputy McManus's point, the priority in terms of general practice should be investment in infrastructure, in the practice and in issues such as out-of-hours services.
A reprioritisation will have to be made if we are to give £600 million – no one knows how much it will cost because negotiations have not yet begun – to provide free GP cover for everybody. Do we go down that road first and expand a system that is acknowledged by all as being inadequate—
If the Minister had not blown it at Ballymascanlon.
—or do we spend the money on enhancing and modernising general practice?
The Minister is wasting time.
I am not.
Will the Minister let me know if the £6,000 income, which may be obtained under the rent-a-room scheme, is taken into consideration for qualification for medical cards? When it was announced in the budget the Minister for Finance said it would not interfere with welfare funding. I have already tabled this question and the reply I was given was that it would be referred to health boards. To the best of my knowledge the health boards have not yet established if income from the scheme will be allowable for inclusion. If the Minister does not have an answer today, he can let me know at a later time.
If general practitioners agreed to a settlement with the Minister on this issue tomorrow morning, there is another problem lying in wait. The problem is with the preparedness of the health boards – certainly the Western Health Board – in processing the applications which will arise. The Western Health Board is issuing the over-70s who have inquired about the matter with the standard application form. They are not prepared to issue anything else until the Minister sanctions the scheme. There will be further delay and further concerns among those aged over 70 years if this continues indefinitely.
The Minister said in answer to my first question that he would facilitate people applying for medical cards in other ways. If they cannot have their application form signed by a doctor, how will they get the benefit in the other ways the Minister mentioned?
In reply to Deputy Timmins's question, if the Minister for Finance said that at the time, that is that.
He said for welfare, not health boards.
I will follow up the matter. He has generally committed himself, in the context of many budgetary changes or increases in social welfare, that changes will not affect people's entitlements.
As regards Deputy Burke's proposition, I have already said that it would be preferable if agreement could have been reached earlier. The Government is committed to this. It is not a huge measure. The matter has been over-heated and the response excessive. At most, it will affect between 33,000 and 40,000 additional people, an average of 23 per general practice. There may be other issues in the background, but what is happening is not justified. In saying that, we have prepared contingency plans to make sure, as from 1 July, people will have an entitlement to what the medical card bestows upon them. There will be new forms.
They are not available.
They are.