Vol. 557 No. 6
3 Ms McManus asked the Minister for Health and Children the reason the Government is not honouring its promise to extend eligibility for medical cards in order to bring in over 200,000 extra people; the steps he intends to take to meet the primary care needs of those on lower incomes who do not qualify for medical cards at present; if it is intended to increase the income limits for eligibility; and if he will make a statement on the matter. [23108/02]
As the Deputy will be aware, the health strategy includes a commitment that significant improvements will be made in the medical card income guidelines to increase the number of persons on low income who are eligible for a medical card and to give priority to families with children and particularly children with a disability. This should be viewed in the broader context of the strategy's emphasis on fairness and its stated objective of reducing health inequalities in our society. Due to the prevailing budgetary situation I regret it will not be possible to meet this commitment for next year but the Government remains committed to the introduction of the necessary changes within its lifetime. As the Deputy may also be aware the GMS scheme costs have increased by more than 29%, which will cost €230 million extra for those currently availing of the scheme.
It should be remembered that health board chief executive officers have discretion in the issuing of medical cards in terms of deciding on hardship cases and so on and also that a range of income sources are excluded by the health boards when assessing medical card eligibility. In addition, in July 2000 the medical card was extended to everybody over the age of 70 consistent with Government policy aimed at improving the position of the elderly.
We have invested significantly in primary care through general co-operatives and the new primary care model that is part and parcel of the health strategy. I announced ten pilot projects earlier this year and will provide €8 million in 2002 and 2003. There is a budget of almost €27 million for the new 24 hour GP co-operatives and the primary care initiative. I regret we are not in a position to extend the medical care scheme next year. I do not have the financial envelope to do so. However, we are undertaking an examination of the GMS scheme in terms of underlying trends.
Does the Minister accept his refusal to honour promises made in the health strategy to medical practitioners and the electorate to extend the medical care scheme to people who desperately need it has caused deep distress to those directly affected? Does he also accept he cannot even convince the Minister for Finance that he has spent his budget wisely? He questioned the Minister's ability to spend money wisely on the health service, which is unprecedented. Does he agree the GMS scheme was recognised as good value in the value for money audit, unlike his Department which was not considered to deliver good value for money?
Is he aware that the full cost of extending the scheme to the 200,000 people who were promised such by Fianna Fáil is only €150 million, which is a fraction of what the Government is spending on the SSIA scheme and only half of what it will cost the Exchequer when it reduces corporation tax? Does this not raise questions in his mind regarding his priorities? Does he accept the decision to refuse to extend the scheme, which means a single person with an income of €132 a week is still denied a medical card, is an indication of a callous and cruel con trick perpetrated on vulnerable people at the last election?
They believed, sadly, that Fianna Fáil would deliver an essential change that would have transformed people's lives so they could afford to pay the doctor's bills when their children were sick and to purchase the medication they needed. Is the Minister not aware of the genuine anguish he caused when he failed to honour a specific commitment made before the election? He has not even delivered it in part. Would he not accept that had it been introduced now on a phased basis, it would have shown goodwill and serious commitment?
Does he accept that, as a result of what has happened, the electorate does not believe him? His credibility is shot. He has denied people a provision that is good value for money, would not require renegotiated contracts, is still under the 40% the GMS scheme allows, is modest in cost and would have enormous health benefits for low income people, the working poor.
The Minister has only half a minute to reply.
It is important to point out that there is a drug payments scheme in addition to the medical card scheme. It, too, has rocketed in terms of expenditure. With regard to value for money in the GMS, the Deloitte & Touche report is wide ranging and identifies strengths and weaknesses within the system—
Not on the GMS scheme.
—but points to the necessity for greater investment. The GMS requires examination, and later parliamentary questions deal with that issue. The rate of increase—
Do not set up a committee, for God's sake.
Prescriptions have gone up by 15% and the cost of the ingredients is going up by a further 15%. When the cost of any scheme rises by €230 million—
The Minister is responsible for that.
I did not interrupt the Deputy.
Allow the Minister to reply.
The Minister is responsible for it.
In what way am I responsible?
The Minister did a bad deal with the doctors—
The time is up. We must now proceed to Question No. 4.
No, hold on a second—
They have the Minister by the short and curlies.
Deputy McManus has attempted to play both sides of the fence on this issue for too long. In advance of the over 70s scheme, Deputy McManus lobbied in the House on behalf of the general practitioners and urged us to do a fair deal with them.
The Minister was craven.
As soon as the deal was done, she changed sides and criticised the content of the deal. However, she did not put on record that she and, indeed, all Deputies—
The Minister did a bad deal.
—voted for the deal. They voted for the extension of the medical card.
The Minister did not do his job.
With regard to credibility, the Labour Party promised free GP cover for everybody in the State—
Yes.
—knowing the finances.
We were told the finances were fine.
They said it was a credible proposal. It was never financed or costed. Deputy McManus knew—
It was costed by the Department.
The Chair is calling Question No. 4.
—her proposal did not have a snowball's chance of ever being implemented in the lifetime of any Government.
The Minister is misleading the House.
I have acknowledged—
I am asking the Minister to take Question No. 4. We are way over time on this question.
I have acknowledged—
I have obviously hit a nerve.
The Deputy has not. Can I speak? I did not interrupt the Deputy.
The Chair is calling Question No. 4.
The Minister should get his facts right.
I did not interrupt the Deputy. I allowed the Deputy to intervene to clarify a point. I regret that I am not in a position to do this because I would dearly love to do it.
The Minister made things worse.
I just do not have the financial envelope this year to do it.
Can we proceed to Question No. 4?
There has been a significant tightening of the fiscal position. I have concentrated on beds and other matters, such as securing 24 hour cover for people. Equity applies across the system. One can argue about access to acute services, primary care services and other services but I am prioritising key areas.
Three questions have been completed. There is an allocation of six minutes for each question but instead of 18 minutes it is now 24 minutes since we began Question Time. It is unfair to Members who remain in the House on a Thursday evening to have their questions dealt with that we do not reach those questions because other Members go over time.
