Deputy Jan O'Sullivan was in possession when this morning's debate adjourned. I understand that two minutes of her time have elapsed.
Health Bill 2008: Second Stage (Resumed).
Question again proposed: "That the Bill be now read a Second Time."
As I said earlier, the withdrawal of the universal entitlement of people over the age of 70 to the medical card will reverse some proven health gains. This regressive and inhumane measure will reduce the peace of mind of such people. We are all aware that the decision to remove this entitlement led to a significant expression of outrage on the streets of Dublin some weeks ago. We owe it to those who travelled from the four corners of Ireland to the Age Action Ireland meeting in a church on Westland Row, and to the Irish Senior Citizens Parliament demonstration outside Leinster House, to fight their cause in this democratic Chamber. The people of the generation in question paid taxes at a rate that the young earners of today would find unbelievable. They saved their money for a rainy day. They did not allow themselves the luxuries people take for granted nowadays, such as holidays and regular changes of home decor. They are the kind of people who made their own sandwiches and got their water from a tap or a well. They would have been horrified by the notion of buying bottled water or sandwiches for lunch. They scrimped and saved their money. They richly deserve something back from the State because they had to watch as this country's riches were squandered on things like PPARS and electronic voting, with little long-term benefit. In the health sector, almost €1 billion in taxpayers' money, in the form of tax breaks, is being given to rich people who are being allowed to develop co-located hospitals on public hospital grounds.
I give the Fianna Fáil-Progressive Democrats coalition Government credit for granting an automatic medical card to everyone over the age of 70. This decision, which was made in advance of the 2002 general election, was one of the few things done to help elderly people. It seems that the medical card was granted only for as long as it suited the Government. When times got tough, the entitlement was removed as part of the first batch of cuts. Similarly, children in classes of more than 30 pupils and 12 year girls, who had been promised a life-saving vaccine, were among the first to be targeted. This was done in a budget that we had been led to believe would be framed in a way that would protect the vulnerable. On the contrary, the vulnerable are taking the brunt of the pain of these cutbacks. As someone who attended the meetings I have mentioned, I am aware that representatives of the Government were taken aback by the size and vehemence of the protests against this measure. Having been in government for over 11 years, it is clear that Ministers, in particular, do not realise what is going on in the real world. They are out of touch. I would have expected the Green Party members of the Government to have recent memories of what it is like for people with small amounts of money who are about to lose their medical cards. Instead, the Green Party Ministers were happy to avail of the shelter of the Cabinet. I accept that a Fianna Fáil backbencher showed the courage to shake the Government out of its complacency and bring about a partial climbdown.
The extent to which the Government is out of touch was made clear when it set punitive income thresholds in the immediate aftermath of the budget. It subsequently had to provide for four changes to those thresholds in the space of a week. Yesterday's announcement that recently widowed people will retain their medical cards for three years is a further climbdown. It will bring relief to a small number of people. Can the Minister confirm that it is legally possible to apply a different rule to different categories of widows and widowers, depending on how long they have been widowed? While I accept that she referred to the matter in her speech this morning, I question the legality of the measure that is being introduced. Perhaps the Minister will respond to that point. This proposal will introduce a further inequality where single people are concerned. I have received a number of telephone calls from people who point out that single people have to meet many of the same household expenses as couples — heat, light and mortgage etc. — but no allowance is made for that. The upper income threshold that applies to them is exactly half of that which applies to couples. As far as I can tell, this is the only means tested measure where gross income, as opposed to net income, is the applicable criterion. This is quite unfair.
I question whether there will be any appreciable saving as a result of this legislation, when the cost of the administration of the means test for the medical card is taken into account. I am aware that the Minister has disputed the €16 million figure that was mentioned earlier in this debate. It is certainly not much more than that. The cost of the administration of the means test needs to be taken into account. What does the Government intend to do in this context in the future? The yearly review will not guarantee that the card will not be removed from more and more people in the years to come. I listened with interest to the Minister's suggestion that there will be an additional 535,000 people over the age of 70 by 2021.
The Labour Party believes that the principle of universal access should be retained. Since 2002, we have advocated a system of universal health care, including free access to primary care for all citizens. The improvement since 2001 in certain statistics relating to older people offers us a snapshot of what such a system could do for the health of the nation. A study published in the Irish Medical Journal in 2004 showed that access to the medical card resulted in older people visiting their GPs more often, an increased uptake of the influenza vaccine and a reduction in the percentage of people over the age of 70 who had a disability. It is not unreasonable to conclude that such improvements have resulted from older people enjoying better access to primary care and improved management of existing health conditions. There is strong evidence to suggest that men enjoy better health outcomes when they have medical cards. Many men tend not to visit their GPs for regular check-ups and monitoring of conditions if they do not have medical cards. In general, they will not visit the doctor unless they have an acute health problem. It is feasible to suggest that there would be a saving in the overall health budget in the medium term if all people over the age of 70 were to be allowed to keep their medical cards.
At the beginning of my contribution, I mentioned that having a medical card is not just a question of having free access to medication and one's GP. One can also avail of services like physiotherapy, supplies like incontinence pads and bandages and access to public health nurses. More than 700 people in acute hospital beds could be looked after in the community if there were places for them. If people are going to lose their medical cards, it will cause more people to end up in acute beds. Not having a medical card will mean they will not have access to the support that would allow them to stay in the community. I know the Minister's policy is that more people should be able to be treated in the community, with which we fully agree. However, this may just be lip service unless funding is given to community care services. Taking medical cards from senior citizens will make it more difficult for them to go back into the community because they will not be entitled to the various other supports, which are very important to people in staying in their own homes.
The Labour Party supports renegotiating the fee for GPs to get the same fee for all medical card patients over 70 irrespective of whether they got it as a result of a means test or a general entitlement. However, that could have been done any time in the past seven years since the introduction of the free medical card for the over 70s. It was not necessary to remove the entitlement in order to renegotiate with the GPs. However, the medical card income thresholds for other people in the community have not been raised for some time. I urge the Minister to include more people in the medical card scheme right across the age spectrum.
I refer to some individual cases of which I have become aware. I have received many phone calls about the loss of the medical card. There is great anger among senior citizens. They are not satisfied with the Minister raising the thresholds under pressure. They want a return of the right they were given. They are extremely angry that this one benefit they got from the Celtic tiger after paying high taxes all their lives has been taken from them. One person sold their house in order to raise funds to go into a nursing home. That person has money in a financial institution as a result of selling the house that has been gradually used in paying for the nursing home over time. That money would bring the person over the threshold in terms of savings. Where does that person stand in terms of retaining the medical card?
A number of people who are living alone have contacted me. Those individuals need to pay all the kinds of bills a couple must pay. Some of them are barely over the limit and will lose their medical cards. I support Deputy Reilly regarding terminally ill people. While I accept they may be able to get a discretionary medical card, there are genuine cases of people with a terminal illness, which can be very costly, who do not qualify for a medical card. That is truly inhuman and cruel. I ask the Minister to address in particular the issue of people who are terminally ill.
I support what Deputy Noonan said about the letter which I also got from the retired secondary teachers in the constituency we both share. The Government initially gave the message that this would only affect approximately 5% of the population who were very rich and could well afford to do without a medical card. However, we are talking about retired teachers, gardaí and nurses as well as people retired from working in the private sector with a limited income. We are not just talking about people in the very high-income bracket. We are talking about people who will genuinely struggle and for whom the peace of mind of having the medical card was a great bonus and the loss of which they will feel greatly.
I question taking medical cards from people who already have them. I question the legal issues of taking a medical card that somebody has as of right. In many cases those cards will not expire for another two, three or four years. Yet those people are expected to hand in their medical cards at the beginning of March. While I know that is being left to themselves, generally speaking people in that age bracket are very honourable and honest. Many of them have said to me that they would feel guilty if they held on to their medical cards. They are being put into a position of having to choose between returning the medical card voluntarily or to live with the guilt that many of them would feel. Why is the Minister taking medical cards back from people who already have them? Is the Minister legally entitled to do so?
I urge the Minister to reconsider this measure. It will not save the Government much money. It probably would have done if the Government had gone ahead with the original proposal to set the income thresholds at a very low level. On 16 October, I raised the matter on the Adjournment. The response was given by the Minister of State, Deputy Barry Andrews, who stated that at that stage the weekly income limit for a medical card would be €240.30 for a single person and €480.60 for a couple. That was the original intention. If it had not been for the outcry on the streets showing the tremendous sense of anger and outrage among our senior citizens and the courageous action of at least one Fianna Fáil backbencher who was willing to stand on his principles, that is how it would have remained. The thresholds only became more realistic in terms of including more people because of the outcry. It would not take considerably more money to restore the full automatic entitlement of a medical card to all over 70s and therefore to restore the sense of the security of knowing they can afford their medication. I believe the change will not save that much for the taxpayer, certainly not in the medium term because there will be more people in acute hospitals.
Today we are dealing with an extraordinarily mean-spirited measure that will save the Exchequer little if any money and will put at risk the health of a sizeable number of old age pensioners. It will take from the over 70s the security and comfort of knowing that if they fell into bad health their savings would not be used up in providing the required care, that their houses would not need to be sold to pay medical bills, that they could go to their doctors or clinic as required and that the cost of medicines would not be a recurring nightmare. That is what the medical card meant to them.
This measure will force all those over 70 to return to the hated means testing, involving prying into their private affairs that they find so repugnant. I know the HSE and regardless of the provisions of the Bill I know what it will do in this regard. The measure will remove the right to a medical card from some 25,000 senior citizens. The medical card for the over 70s was an acknowledgement of the service to society provided by senior citizens. It was they who struggled through the hard times and paid more than their fair share in high taxes. I cannot believe the Government is now proposing to withdraw this long-established right. It is not only the rights to a medical card for the over 70s but also the much longer established right of the over 80s to that entitlement. Some of these people who have had medical cards for ten years are now in their 90s and will have it withdrawn.
The Bill is the legislative measure designed to deprive old age pensioners of their right to a medical card. The Government, composed of Fianna Fáil, the Green Party and Independents, is proposing that a majority of the House vote either electronically or by walking through the lobbies to remove the right of those over 70 to a free comprehensive medical service and replace it with a means-tested system for all, which will exclude 25,000 pensioners from health care at a time when they most need it. The Government has a majority of six in this House of 166. For this measure to be stopped in its tracks and rejected all that is needed is for four Green, Independent or Fianna Fáil Deputies to vote for the pensioners. If they were to state their intentions clearly there would be no vote at all. The Government would be forced to withdraw this mean-spirited measure that targets the old when they are infirm and sick. The question is whether any of the four Members on the other side of the House have the guts, the bottle, the courage or the gumption to stand up for the old among us.
Government backbenchers should be aware that old people are not only hurt by their actions but they are also very angry. They are angry that backbenchers targeted them by supporting this measure which attempted to deprive all old people of medical cards and the accompanying services. These people are angry that the Government withdrew the original proposal only in part in the face of their huge demonstration. Many of the old age pensioners who are loyal and longstanding supporters of Fianna Fáil are angry and shocked at the party's betrayal of them. This was best demonstrated when Government Members gave this measure and other cuts a standing ovation in the Dáil.
I say to the Government backbenchers that if they cannot find it in their hearts to reject this measure and support senior citizens, then perhaps they will do so to save their own skins and their seats. Let them not forget that many of the people who are affected and angry are lying in the long grass waiting for them. Deputy Joe Behan, a heart and soul Fianna Fáil man, found the courage to do so because it was the right thing to do. He now holds what is probably the most secure seat in this House.
Not quite.
The point is taken. How we treat the old among us is a measure of our civilisation. This measure, if passed, will be a major step backwards in that regard. I have no doubt that the significant majority of decent Members of this House, including many on the Government benches, do not support this Bill. It is being forced through by the right-wing ideology of the Minister for Health and Children, Deputy Mary Harney. She could not bear or countenance any universal application of service and insisted that a means test be introduced, even if little or no money were to be saved. Let it be the last sting of a dying wasp. The poor, the elderly and the sick have suffered the misery of her stings for the past four years. Let us give her a going away present by rejecting this mean ideologically driven measure that has terrified and angered old age pensioners and almost fatally damaged the Fianna Fáil dominated Government.
Take heed of me now.
She is still stinging.
She is still stinging, indeed.
I welcome the opportunity to speak on this Bill. I do so on behalf of very many of my constituents who have been in touch with me and continue to be on what is almost a daily basis. Their immediate concerns are about this measure but they are bothered also by the extraordinary level of confusion that seems to dominate their waking hours because they do not know exactly what the situation will be once this Bill is enacted.
I found breathtaking the arrogance of the Government on budget day in removing the medical card entitlement from those aged over 70. It was a gross approach to penny pinching. On budget day that was the single item that jumped out at me from all the other cuts declared. I found it incredible that the entitlement and small benefit that had been given to our senior citizens was to be removed from them in one fell swoop. It was extraordinarily disconcerting and lacked any consideration for their wellbeing because of the impact it would have on their financial status and on their psychological wellbeing.
Although it was breathtaking to hear what was said on budget day, it was equally breathtaking to see what happened in Molesworth Street and at the other meeting in the church in Westland Row where so many senior citizens turned out in force. They were more vocal than any of us would have expected them to be on that day. Despite what might have been taken for granted about them their spirit is alive and well. It was because of the events on those two occasions that the first of the partial U-turns was taken with regard to the budget. It is true that the decision caused panic and terror up and down the country, not only to those aged over 70, but also to their family members. They, too, have been in touch, sons and daughters of people affected who are concerned for their elderly parents. I still get such telephone calls on a regular basis. That is the reason I oppose this Bill, with the Labour Party.
The dilemma about automatic entitlement to the medical card for those aged over 70 started out as a political stroke designed to win an election in 2002. The measure was not agreed with doctors prior to the political announcement being made. As we now know, the consequence was that the doctors had the Government over the proverbial barrel with regard to payment and to striking a deal. In typical Fianna Fáil style, the Government once again proved profligate with taxpayers' money and ended up giving general practitioners a significantly greater payment for treating over 70s than they received for other medical card holders. There was no logic to this agreement except that the Government had played the vote catching game and subsequently had to play catch up with the general practitioners and pay them. I do not object that the over 70s were given the medical card at the time. I supported the measure then as I support it now. I make the political point that at the time its introduction was a political stroke and nothing more.
That did not seem to matter to the Government as long as the construction sector kept on building. From June 2007, the Agreed Programme for Government between Fianna Fáil, the Green Party and the Progressive Democrats promised to index link the income thresholds for medical cards to increases in the average industrial wage. Now that the building has stopped and the economy is in a tail spin, the Government, in a panic, seized upon the entitlements of the weakest in society, the elderly, and young people in education. It thought it would be able to pull another stroke while protecting the fat cats in the banks and the property moguls. How wrong it was. The sight of over 15,000 pensioners and their supporters lining the streets was a fantastic testament to democracy and to the determination of the elderly not to be sidelined or to have their rights removed.
On the other hand, I must emphasise the sense of fear, misunderstanding and genuine anger that is abundantly clear when one talks to those people. This happens every week at my advice clinics and through an unprecedented number of contacts, by e-mail, telephone and every other way that one can imagine. Everybody one meets on the street is still talking about it and still showing concern.
Although the Government harped on about a call to patriotism, this seemed to be a short-sighted money collecting exercise. What the Minister failed to realise was that automatic entitlement to the medical card makes a lot of sense from a treatment perspective. I am one of those who believes very strongly in preventive medicine and my view is that this is an area that could, and should, have been retained. In this country we are very limited in our approach to preventive medicine and we are constantly playing catch up. When something happens we try to remedy it. Why do we not try to put down blocks in the first place to prevent it happening? It should be done and it would have worked very well with the medical card for people aged over 70. The long view should have been taken here. Apart from saving money we could have looked at ways of preventing stress and ensuring a better quality of life for those people. People who can afford to go to the doctor at the first sign of illness remain healthier. That is well established and other speakers have mentioned it today. This afternoon I received a publication from UCD where some research has been done on this factor. This very point was made in that publication with regard to the health and quality of life for older people. It is also the case that people who can access their general practitioner do not spend as much time in accident and emergency departments and in acute hospitals. Space is thereby freed up in our desperately overcrowded hospitals.
In its panic and desperation at the sheer wave of hostility to the cuts, the Government flipflopped on the issue several times before finally agreeing to increase substantially the thresholds for eligibility. I already mentioned confusion. There truly was confusion and consternation among older people and I am afraid that it has not gone away, unfortunately. We have all spoken of and heard about those people who are just outside the income limits, the retired civil servant, garda, teacher and others. These people will be caught and will no longer have an entitlement. My concern is that there is nothing to stop the Minister or her successors lowering the income eligibility that has now been defined, or failing to index link it to inflation in the long term. This is simply not acceptable. The automatic right to a medical card, whatever their ulterior motives at the time, was one of the few positive steps taken by the Government to help the most marginalised in society.
There is another issue that has been brought to my attention, and I understand the Minister addressed this within the Bill. It relates to people who have medical cards that do not expire, for example, until 2013. Are they supposed to return their cards if they are over the income limits? I appreciate that this issue is dealt with in the Bill. When I spoke to a number of these people last Saturday they assured me that whatever the content of the Bill, they would be taking whatever legal advice is available to them and they will be making every effort to ensure that entitlement is retained. The way they see it is that they have a contract with the Minister and feel they are entitled to the value of that contract. They have assured me they will be taking whatever action they can.
For a number of people over 70, their chances of substantially maintaining their quality of life have been seriously damaged by the removal of the medical card. Our elderly deserve better, and I hope the Minister will review the situation and restore the medical card to those people.
I would like to share time with my friend, Deputy Bobby Aylward.
Is that agreed? Agreed.
I welcome the opportunity to make a brief contribution to this important debate. I will not reply to many of the red herrings. This is a typical case of "damned if you do, damned if you don't", because when this measure was first introduced, as I understand it, there was opposition from other side of the House. I do not want to be too political on a damp December day, but the Government was criticised for introducing this measure, and now it is being criticised again. There has been much talk about what backbenchers did, which ones were heroes and who did what. It is a bit like 1916 — everybody seems to have been there.
The Deputy might still have his chance.
There were more people on the streets a few weeks ago.
I will deal with that. I am not afraid to deal with it because I am a proud Dubliner and I was out there that day.
The Deputy was protesting.
I know that people were upset, angry and confused. In fairness to the previous speaker, she was absolutely right — that is a fact. I was quoted in The Irish Times as making such a statement, so I must have said it, because The Irish Times would not report anything that was not true. I went about my business, and instead of taking a stand similar to that of my colleague, which has now been highlighted — I have no problem with that colleague — I and others stayed on the battlefield and worked away within the system. We got a message across to Government and to the Minister that this decision had caused many problems. I am on record as acknowledging it caused anger, confusion and upset. I am glad that changes were made following various meetings of the Fianna Fáil parliamentary party and other interventions by colleagues. That is as it should be. It is important that we continue to understand that this is our role and we should not be afraid to carry it out. There is a myth, which I must disprove once again, that if one is on the Government benches one does not have a role to play. I do not want to rile my colleagues, but as I have said before, I would be just as happy, the odd time — not too often, but the odd time — to be on the Opposition benches so I could say anything I wanted.
The Deputy might get a chance soon.
It is sometimes tough being on the Government backbenches, but I would not have it any other way because one can get things done. I have seen colleagues, even today, express huge frustration with being on the Opposition benches. I am not being smart about this, but I understand it.
It is the frustration of not being able to influence things.
Allow the Deputy to continue without interruption.
The Deputy addressed his remarks directly to me.
I apologise if I provoked the Deputy. On either side of the House things happen and things are decided and announced which we are not all happy about. Deputies should not think that life on the Government benches is all that easy or that we are happy with everything.
We feel the Deputy's pain, I promise.
We are hurting.
One plays the cards one is dealt and one goes about one's business.
That is what the over 70s want to do — deal with the cards they were given.
In my case, I go about my constituency. I go to every street in Dublin South West and listen to what people are saying, and then I come in here and convey that to the best of my ability and try to effect change. I hope that I and others will be credited with doing this because that is exactly what we did. We were not afraid to do it. That is what we will continue to do. In fairness to my party, over the years we have demonstrated support for the rights of senior citizens, as we should. We are all aging — aging quickly, in some cases. I understand that and it is very important. I live in a community with a very young population, although we have an aging population too. I spend as much time as any of my colleagues with senior citizens' groups. I am on the board of the Tallaght Welfare Society and I go regularly to the senior citizens' group in Glenview and the south Dublin senior citizens' group at Tymon Bawn Community Centre on Firhouse Road — a place Deputy Shatter will know, as he almost represented it in the past.
It is important that we continue to listen to people and to knock on the Minister's door and tell her what they are saying. I hope Deputy Harney — who does, despite what some Deputies think, have a reputation for listening to people — will understand there is still a need to examine all these issues. She has a difficult job and she knows well that I would be just as happy standing here and talking for the next two hours about Tallaght hospital, about cancer services and about all the things I need in my constituency, but she also knows that as far as this issue is concerned there is a point of view to express. The Minister will always have to balance her budget and will always have to listen to the various lobbying and interest groups who have all sorts of issues to raise with her. She has made changes to the medical card proposal, and I hope she will continue to look in a favourable way on the reasonable points that are made to her.
I note that approximately 370,000 persons aged 70 and over have a medical card. I am told that 214,000 have a means-tested medical card at the standard GP capitation rate, while approximately 140,000 have a medical card that attracts the higher GP capitation rate. I also understand it is expected that nearly 95% of those aged 70 or over will continue to have a medical card under the new arrangements announced by the Government. I am sure the Minister will take the opportunity during the course of this debate to confirm those facts. As I said earlier, the automatic entitlement to a medical card for people aged 70 or over was introduced in 2001, and at the time of introduction approximately 260,000 people aged 70 and over had a means-tested medical card at the standard GP capitation rate. At the end of 2001 a further 64,317 people had been granted a medical card at the higher annual GP capitation rate without means assessment. This number has risen significantly over the years, and at the end of September 2008, 180,000 people had been granted a medical card without means assessment at the higher GP rate, while a further 216,000 held the standard-rate medical card. In a perfect society everybody would be facilitated and everybody would get benefits.
The presence of Deputy Enright reminds me that we were at a meeting of the Joint Committee on Social and Family Affairs this morning at which serious issues of poverty, deprivation and social inclusion were raised. I did not hear all the heckling that came across because I was trying to concentrate on using my few minutes constructively. We all have to participate in political debate, but where points of view are expressed I certainly listen to what colleagues are saying, and I understand that they have to articulate their concerns. I hope they respect the fact that I have to do the same and will continue to do so. When people contact me about difficulties they have with medical cards — I am not speaking only of the over 70s, as colleagues know, but all categories — I sometimes have a problem trying to figure out why, if the HSE is working according to guidelines, some people lose their medical card or do not receive one because of a small difference in money, bearing in mind that they have particular medical challenges. I will always regard this as problematic.
A long time ago I was thanked for getting a person a medical card. I told that person very quickly that I did not get the medical card nor could I. As the local public representative I had persuaded the system that this person was entitled to something to which the system had decided he or she was not entitled. This is the role of the public representative. I will listen to all the contributions to this debate.
The intensity of the public debate over the automatic entitlement to a medical card for the over 70s age group has been ferocious and the public response has been extremely hostile. I believe much of this commotion was founded on misinformation and deliberate distortion of the facts.
It is very important that the central thrust of this Government's intention should not be lost in all the emotion, all the political drama, and all the arguments which have been played out everywhere since the budget. We must all understand that we are now living in severely altered circumstances compared to those which prevailed up to very recently. The harsh reality is that our revenues are vastly depleted compared to those formerly at our disposal. We have a lot less money to share out and there are ever-increasing demands on the public purse. We have no choice but to make judicious decisions about where and how that money is spent. We have so many competing and deserving interests but the onus is on the Government to ensure that the taxpayers' money is spent carefully and invested prudently. The Government is compelled to make these strategic decisions based on the long-term view and the bigger national picture.
We have to bear in mind that this Government is motivated purely and simply by financial practicalities and financial constraints. The Government has at all times acted in the utmost good faith. Its clear intention is to economise and to allocate the available resources evenly and fairly while at the same time identifying areas of spending which can be reduced. This Government is driven by the clear need to cut its cloth to suit its measure and every decision is predicated on this. The budget was formulated in the context of a lot less money to go around and on the overriding imperative to direct those scarce resources towards those who need them most. There is absolutely nothing inherently wrong with that principle as it is basic common sense. It is not the intention of the Government to victimise any section of our society. It is not its intention to cause hardship or anxiety, rather this is a genuine attempt to tackle some of the more expensive aspects of the services which this State provides to its citizens on a daily basis.
The automatic entitlement to a medical card, irrespective of one's means, has long been considered to be an unduly costly facility. In my view, the original decision was not correct. It was particularly costly in terms of the capitation fee which was paid to administer the scheme. As of 1 October 2008, there were just over 139,000 medical card holders who did not have to satisfy a means test. Of the medical card holders aged 70 and over, the total number was increasing by between 2.5% and 3% per annum. However, medical cards issued on an automatic entitlement basis were increasing at over 7% per annum. The Minister has said repeatedly that it was not possible to sustain this scheme in the medium term because of the escalating costs and the fact that we will have diminishing revenues for the next couple of years. The truth is this scheme cost the Exchequer €245 million last year alone which was much more costly than originally anticipated.
The Government's purpose was to dismantle elements of the existing scheme in its current guise because it is difficult to justify its overall costs. The intention is to obtain real savings in the region of €100 million in the overall scheme and to bring it more into line with the costs attaching to the other medical card schemes.
The capitation fee associated with the over 70s medical card was astronomical relative to the cost of the regular medical card arrangement with the GPs and it simply did not stand to financial reason that it should be so expensive. The IMO played hardball with the Government in 2001 and extracted a high price from the State for its participation in the scheme.
Whose fault is that?
However, I am delighted that the IMO has now acted very reasonably having regard to the financial limitations being imposed on us and the absolute need to achieve savings everywhere. The new capitation rate is €290 and it is envisaged that this will secure savings in the region of €16 million next year.
In my view, excess hysteria and deliberate confusion were whipped up about this controversial budgetary measure. Such was the intensity of the debate and the blurring of the facts that people over 70 were needlessly terrorised into thinking that the Government was hell-bent on removing the medical card from everyone over 70. The Government was deliberately demonised by those who were determined to embarrass it and they shamelessly played on the fears of every medical card holder in this country. This is despicable and inexcusable. Political opportunism was dressed up as feigned concern for the elderly and their fears and insecurities were brazenly exploited.
There is no doubt that the medical card issue was traumatic. People were outraged by the prospect of the removal of the medical card. They were worried, angry and frightened and their reaction provoked huge passion and public sympathy. I reiterate that I believe the Government was acting with honourable intent and that the bona fides of its proposal were completely genuine.
The Government is forced to operate within the current parameters for public spending and to do otherwise would be reckless and do untold damage to the country's long-term monetary strategy. As a public representative, I have spoken to several people who have serious concerns about their predicament. They were concerned about the hardship which this measure might inflict. Many of those who approached me were very anxious but when I asked what was their understanding of the measure they had assumed that the medical card would be discontinued for everybody, irrespective of their means or their ability to pay. They understood that the proposal would impose a blanket removal of the medical cards for everyone over 70 years of age. This was a myth which the Opposition chose not to dispel. On the contrary, the Opposition reinforced the myth because it wanted to cause needless confusion and despair among so many people. It is always difficult to revoke an entitlement which has been granted.
People become used to having that valuable facility and organise their spending accordingly. There is no doubt that many people would have been excluded from the medical card entitlement in its original form and this would have caused considerable distress and anguish to the over 70s and to their families who were to lose the entitlement by virtue of their means. This age group is vulnerable when it comes to their health and well-being. They are understandably concerned to ensure their future security and quality of life.
It is for that reason I am very happy that this Government behaved wisely and reacted swiftly and with sensitivity.
The Deputy cannot expect us to take that line seriously.
It has acknowledged its commitment to afford special care to the elderly. It has recognised, without any ambiguity, the singular contribution made by this age group to the national economy and to society. I am delighted that the Government decided to revise the income threshold up to €700 gross weekly or €36,500 annually for a single person and €1,400 gross per week or €73,000 annually for a couple. Now 95% of people who are over 70 will retain the medical card. This amounts to approximately 20,000 people and some of these people may be entitled to apply for a discretionary medical card if they are experiencing particular hardships, health problems or high medical expenses. Some of these may also be covered by the drugs repayment scheme, which also provides a good cushion.
There is another element to this debate which is relevant and worth noting so that everyone is clear about their entitlements. I am glad to see that the element of means testing has been retained for this medical card, as is the case with all other medical cards. It is generally accepted that people who can afford to pay should pay for the services they receive. Virtually no one disagrees with that principle. No one expects the taxpayer and the State to carry the entire cost for those who have sufficient means to pay their own way. In an ideal world with infinite resources, it would be desirable to retain the concept of universal or automatic entitlement but the pressing reality now is that we just cannot afford to extend that luxury to everyone. While there may be some resistance to the introduction of a means test, it is a fair basis on which to disburse limited resources and ensure that available moneys are delivered to those who need the support of the State to meet their daily needs.
A total of 5% of the over 70s population can afford to pay for professional medical services, therapies and pharmaceutical drugs. I do not believe that anyone of that age cohort, who has more than adequate means, would refuse to pay or would realistically expect the taxpayer to bear his or her costs. It is only fair and equitable that those above the new weekly threshold of €700 gross income per week should in fact defray their own medical expenses. I know they will regard this as a very reasonable proposition. Furthermore, virtually all of that 5% of the over 70s population have private health insurance and may also be availing of the State's long-term illness scheme.
The revision of this medical card income threshold will come as an enormous relief to all those who felt they were being affected. The increase in the threshold is substantial and it will ensure that the majority of the over 70s population will now be catered for. The onus now rests on the Government to find the savings of at least €64 million elsewhere in the Department of Health and Children.
I am pleased that it has signalled its willingness to review the drugs scheme and to investigate the possibility of dispensing generic drugs where this is appropriate. I have long been an advocate of effecting economies within the dispensing system and I believe that pharmacists generally are supportive of this initiative. Medications are expensive in this country and it would be infinitely sensible to explore prescribing generic medicines where a suitable alternative to the branded drug exists and provided it is safe and effective for the patient. There is scope for significant savings in this drug initiative and all the parties concerned can work together to achieve greater cost efficiencies when it comes to prescribing and dispensing medicines. For these reasons I commend this Bill to the House.
I wish to share time with Deputy Enright.
Is that agreed? Agreed.
I listened with amazement to the offerings of Deputies on the Government backbenches. Deputy Aylward has just informed us how delighted he is with the provisions before the House. It brings me back to budget day when this debacle first started. In the forefront of my mind, I have Fianna Fáil and Green Party Deputies, and the two Deputies of the Progressive Democrats as they then were, standing in a round of hysterical applause to congratulate a Minister for Finance who looked somewhat out of his depth.
Since then there have been five U-turns on the medical card for the over 70s issue. This afternoon, we have had a sixth. I have already put on the record of the House my opposition to this change in the law. I believe it was right to extend the medical card to people over 70 years and that they should continue to retain it. There are substantial health benefits in not applying a medical card means test to the over 70s and substantial economic savings to the State when people get access to medical care faster than would otherwise be the case.
I do not accept the capitation payment as being a great victory secured by the Government. The truth is that it was always illogical that doctors were paid a ridiculously low sum of money for caring for those over 70 who had the medical card on a means-tested basis while then being paid an enormous sum of money for those who did not go through a means test at all. The Government simply decided to target persons over 70, causing a great deal of stress, fear and confusion throughout the community. Any Government organising its business in a coherent way would have engaged in discussions with the medical organisations to agree a new capitation payment well in advance of the budget. This would have ensured a more sane and coherent approach to the issue.
Based on promises made in 2001, and the subsequent legislation, those over 70 have a legitimate expectation that they will continue to have a right to retain the medical card. If the Government attempts to deprive people of it, based on the provisions contained in this ill-thought out Bill, particularly those in section 7, it will run into serious legal difficulty.
The Government may be engaged in a nod-and-wink routine anyway. Anyone over 70 years on 2 March next who considers themselves no longer eligible for the medical card based on the financial thresholds in the legislation is under an obligation to report their lack of eligibility to the HSE. It is important that those who have legitimate expectations are aware of the likely consequences if they do not report to the HSE. The Government might inform us if there will be groups of inspectors knocking on the doors of the homes of the over 70s seeking to get back medical cards they have been using for several years.
Failure to report ineligibility also makes one liable to prosecution under section 49 of the Health Act 1970. If a person knowingly fails to report if his or her means exceed the thresholds set down by this legislation, then he or she is at risk of being fined £50 in old money, which I reckon is €63. Will those who do not report to the HSE be prosecuted? Is the Government serious in trying to deprive anyone over 70 of their medical card or is it involved in a nod-and-wink routine? The Government must come clean about this because there is no serious penalty for someone who does not report their ineligibility. There is no reason why elderly people should be given unnecessary worry. The Government should, in fact, change its mind and not deprive anyone over 70 of a medical card.
I want to highlight one issue which the Government and the Minister for Health and Children obviously came to as an afterthought. It is referred to in this morning's The Irish Times, no doubt an inspired leak to deflect criticism from this debate. It is also an addendum to the Minister’s speech.
The Bill is ill-thought out even having had a gestation period of three months. It was published only last week. It contains no provisions of any description to address the position of widows and widowers. Within our income tax legislation and our general social welfare code, there are various provisions to specifically ensure that a bereaved spouse on becoming a widow or widower is not penalised financially by the State as a consequence of their bereavement. In this respect the Bill constitutes a naked political assault on widows and widowers. Its provisions, if implemented in full, will mean that a person over 70, who through bereavement becomes a widow or widower and as a consequence has €1 in excess of the €700 threshold, must inform the HSE they are no longer eligible for a medical card. It is an obligation to notify the HSE of this before the deceased spouse is buried. They may even be prosecuted under section 49 of the Health Act 1970 if they do not.
What Government would publish legislation that requires someone over 70 to report that to the HSE before they bury their spouse and, if they fail to do so, be liable to prosecution? Has any thought been given to the implication of this measure?
In an addendum to her speech, the Minister stated, "The Government has been concerned at all times in these new arrangements to ensure that a person aged 70 or over would not lose their medical card as an immediate consequence of the death of their spouse". That is untrue. The Government has not been so concerned.
I raised this issue two months ago on a Fine Gael Private Members' motion opposing the proposed changes to the medical card legislation. I warned the Government about this problem, yet it has still failed to address it in this Bill. The Minister earlier said some amendment would be introduced to ensure a person will not lose a medical card immediately upon the death of a spouse. The Irish Times today reports widowers and widows will be allowed their medical cards for three years. I do not know whether that is accurate. Is the Minister telling the House that if a 72 year old wife loses her husband, when she reaches 75 her medical card will be taken from her? What type of social policy is that? What type of health policy is it?
Even more extraordinarily, in the Government's definition of couples it has missed a crucial issue. I am not suggesting that a couple living together outside marriage, an elderly man and woman, should be discriminated against compared to the husband and wife living together. This Bill discriminates against widows and widowers in an unconstitutional, unsustainable and indefensible fashion. Under the Bill, a 74 or 75 year old bereaved widow or widower can be deprived of a medical card in circumstances in which the income is less than the income of a 74 or 75 year old man or woman cohabiting with someone else. We have a constitutional provision that seeks to protect the family based on marriage and, as a minimum, directs this House not to discriminate against an individual as a consequence of being married. The manner in which the Government has dealt with widows and widowers in the legislation as published, and the minimal change the Minister is now proposing, which will result in a widow or widower being deprived of the medical card, is unconstitutional because preferential treatment is given to an unmarried individual over 70 cohabiting with someone else. It is contrary to Article 41 of the Constitution. If it were challenged it would not constitutionally withstand the challenge.
If the President was to refer the Bill under Article 26 to ask the Supreme Court to address that issue, the Supreme Court would have no choice but to find this provision unconstitutional. If the Minister will not allow all persons over 70 to retain the medical card and if she insists on applying a form of means test, at the very least where persons over 70 have already been given a medical card, she should not deprive them of it as a consequence of being widowed or becoming a widower. She should not deprive them of it as a consequence of a bereavement and she should not introduce a measure that gives them some licence to retain the medical card for a short period and take it from them afterwards. If she does, that will not withstand constitutional challenge.
I welcome the opportunity to revisit this issue. I was interested to hear the comments of speakers opposite, particularly the accusation of political opportunism. After the budget, I spoke with my father who represented Laois-Offaly for a long number of years. He referred me to a comment by a colleague from the benches opposite when the vote was originally taken in 2001 about how we were making the biggest mistake of our political lives and that we would pay dearly for it. We can now throw back that comment at our colleagues. This has been the least thought out and worst budget decision in recent memory.
I want to give the lie to the unofficial line peddled by Fianna Fáil Deputies and councillors, that this was a civil servants' budget and that it was not really a budget by politicians. People have been happy to peddle that line around the country to divert blame from themselves and their parliamentary and democratic responsibility in this House. I should not say I am glad if a civil servant leaked anything and I do not know who leaked this but I am glad that a statement appeared showing the memorandum that went to the Minister for Finance on this issue. This made it very clear that it was a decision that would not wash well politically. It took a civil servant to realise that the decision on the medical cards was not one the public would accept. It took a civil servant to see the political consequences of the decision. Two months after the budget, it amazes me that 15 men and women sat around a Cabinet table and not one realised the consequences this decision would have for ordinary people. Despite the 15,000 people who appeared on our streets, 1,000 for every Cabinet Minister, they still do not realise the pain they have caused.
Deputies opposite referred to the chaos and confusion. We did not cause that. Five separate eligibility criteria were published between the Department of Health and Children and the HSE on the medical card limits in the days after the budget. Every Government politician who spoke gave different figures. The Taoiseach, the Tánaiste, the Minister for Health and Children and the Minister for Finance had different and confused figures in respect of this. That is where the chaos and confusion arose as a result of this decision. It was made up as they went along. That is why we find ourselves dealing with this legislation today.
The Government thought it had chosen the easy option. If there is one positive element to this, it is that maybe the Government will realise that the elderly people of this country cannot be taken for granted. I am not convinced yet that the Government realises this. Nobody bought the platitudes from the Green Party on the day of the protest, that the party would never take old people for granted again. It was stomach churning to listen to it.
I dispute the figures provided today in respect of the figure of 5%. Deputy O'Connor referred to the meeting of the Joint Committee on Social and Family Affairs this morning, when the word "millionaires" was thrown across the floor. Members referred to millionaires and High Court judges, who they must think are very unpopular. This is being repeatedly referred to. I refer to a memo from a meeting I held with the Offaly branch of the Retired Teachers Association. These are primary school teachers and each one over 70 who I met will lose the medical card. I have yet to meet a teacher who is a millionaire. The Minister of State, Deputy Hoctor, was a teacher and is better off now but is not a millionaire. Her colleagues over 70 will not have a medical card if they had any increment for an extra post of responsibility. The figures speak for themselves.
Retired teachers employed prior to 1995 are not eligible for dental or aural entitlements to which anyone else in the PRSI system is entitled. They have already been penalised in that. Everyone knows of the health deterioration that comes with the aging process. A real and genuine fear is that the expense will deter people from seeking medical care. They are caught every way in respect of the changes to this.
The notion of responsibility on the individual to declare is almost unworkable. From Deputy Shatter's figures, the idea of anyone reporting themselves rather than risking a €63 or €62 fine is depending on them to very honest. Aside from honesty, there will be chaos when the letters and forms arrive. I have yet to see a simple form from any Department. If they were so simple, Deputies would not spend time in clinics filling them in and helping people to fill them in. They are not simple. It will be interesting to see the simple version. Either the Department needs the information or it does not.
I refer to those who do not qualify, who will have their cards taken back by the Government and who can get a card with discretion if they are seriously ill. I do not trust the way the discretion will work. Sick people who should be trying to get better will spend their time instead contacting politicians and HSE officials in an attempt to retain their medical cards. The use of gross income for threshold is a mistake and it is extremely unfair.
I refer to the living alone issue raised by Deputy O'Sullivan. We had a lengthy discussion on this during the debate on the Social Welfare (Miscellaneous Provisions) Bill last week. A one-person household incurs 70% of the expenses of a two-person household. The criteria for the threshold will penalise those who lose a spouse because their medical card will be taken from them, which is wrong.
I am happy to have the opportunity to contribute to this important debate. The Bill gives effect to recent Government decisions to end the automatic entitlement to a medical card, irrespective of income, for people aged 70 and over, and to introduce new arrangements in order that the vast majority of these people will continue to have medical cards under a new income threshold. There are good policy reasons for introducing this legislation. In particular, it enables the ending of the high capitation fee for GPs that has been paid since 2001 only in respect of over 70 year olds who received a medical card by virtue of age rather than means. The fee was paid for approximately 38% of people aged 70 and over. People in general are pleased that the perverse incentive this special fee created between different GP practices is being ended. While some people do not want to admit it, GPs were willing to point out there was a high concentration of GP practices in our larger cities where incomes were higher while the number of practices in disadvantaged areas has reduced. This legislation will put an end to that and there will be equal spread of GP practices, which will be near people, and services will be provided to those who need them most.
People aged 70 years and over are more likely to require regular access to health services and it is appropriate that additional support be put in place to enable their access to medical care. At the same time, it is consistent with the general approach of the GMS for many years and with the need to provide for financially sustainable schemes that the scheme should be limited to all but the top 5% of income earners among over 70s. There are, and will continue to be, pressing calls on scarce resources to meet the needs of many people across the range of health services. It is appropriate that we devote taxpayers' funds to meet those needs.
The number of people aged 70 and over in our population is 350,000. It is projected this number will increase to 363,000 by 2011, 433,000 by 2016 and 535,000 by 2021. We need to plan for, and provide, many health services for the people now aged 55 and over who will form the over 70s group at that time and use public resources in the most effective and fairest way to provide those services. It is easy for the Opposition to ignore our growing aging population as people, thankfully, live healthier and longer lives but the Government must address the projected figures and look after those who need care most. We must base the assessment on this and people's ability to pay.
As outlined by the Minister earlier, the continuation of the automatic medical card, and the high capitation fee paid for it, does not represent prudent or fair financial planning. We should concentrate on using resources for those with the greatest medical and financial need. The Bill provides that those who are aged 70 or over before 1 January 2009 and who had full eligibility on age grounds will continue to have full eligibility as long as their gross income from all sources does not exceed the specified limits. The medical card is evidence of full eligibility. These generous limits are €700 per week gross in the case of a single person, excluding any income from savings or similar investments whose principal value is €36,000 or less, and €1,400 per week gross in the case of a couple, excluding any income from savings or similar investments whose principal value is €72,000 or less.
As the Minister said, a person who had automatic entitlement to a medical card, and, therefore, full eligibility, will continue to have full eligibility until 2 March 2009. Consequently, all persons can continue to use their medical card as normal until that date even if their gross income exceeds the relevant income limits set out in this legislation. The Government wants to ensure the process of self-assessment for elderly people will be much simplified compared to that required under the existing "hardship" based scheme. Consequently, the HSE has been asked to ensure any assistance a person who is currently over 70 may need regarding self-assessment be made available on an administrative basis.
A much simplified means test will be arranged for people reaching 70 on or after 1 January to enable them to apply under the new arrangements. They will receive confirmation from the HSE that they have full eligibility and will continue to have full eligibility as long as their gross income does not exceed the relevant limit. The Government is also providing in this legislation for the dependants of people over 70. The Bill also includes a provision to amend the Health Contributions Act 1979 to provide an exemption from the health contribution for any person, who is or reaches the age of 70 on or after 1 January 2009. The amendment will exempt everybody over 70 from paying the contribution regardless of whether they fall into the categories exempted under section 11 of the 1979 Act.
The legislation is designed to give effect to the Government's decision to replace the automatic entitlement to a medical card for persons aged 70 and over with a new arrangement based on gross income limits. As the Minister outlined in her contribution, she has examined a range of options to protect persons aged 70 and over who lose their spouse. I lobbied her to address this because this must be recognised as a difficulty. The medical card should not be lost on the death of a spouse and I understand, on the basis of work on this issue over the past number of weeks, that she proposes to introduce an amendment on Committee Stage in this regard.
Opposition Members are suffering from amnesia. Deputy Enright was quick to quote the contributions of Government Members on this issue in 2001 but Deputy Noonan, when serving as Minister for Health and Children, stated on 19 December 1996:
In those circumstances I do not think that it is justifiable to extend an automatic entitlement to a medical card to all citizens aged 80 and over without reference to their means. I am satisfied the health boards will assess people according to their circumstances.
Thankfully, the HSE continues to do so. Deputy McManus referred to millionaires with medical cards as an "obscenity" in November 2004. She said:
In Ireland millionaires have been created by our economic boom. In 2001 we know now 11 of these millionaires paid no tax at all. If any of these millionaires, whether tax paying or not, is over 70 years of age, they automatically qualify for a medical card. This is an obscenity when compared to the experience of ordinary hard working families.
Millionaires are not the only people who will be excluded. What about retired teachers and nurses?
The Government has adopted a practical approach in recent years to improving the lives of older people. Our growing aging population must be recognised and the figures used in 2001 do not compare to the current projected figures. Most of us would like to live as long as possible with services available to us. However, services must be provided for those who need them most and who cannot afford them. More than 95% of people aged 70 and over will retain the medical card, which is important. The Government has made a commitment in my appointment as Minister for State with responsibility for older people to look after our elderly and it is a priority for Government. The establishment of the Office of the Minister of State with responsibility for older people in recent months has led to unprecedented funding increases through the HSE. For example, the total funding provision this year to allow the HSE directly support a range of services for older people is in the region of €1.8 billion. More than €800 million of this is ear-marked for residential care services. Since 2006, in excess of €200 million new funding has been made available to develop or expand community-based services such as home care packages, home-helps, meals on wheels and day and respite care. Our aim has been to ensure that older people receive as much care as possible in their own homes; that high standards are set and enforced in all residential care settings; and that the cost of residential care is always affordable and not an anxiety.
The western world enjoys, as never before, the opportunity of aging. Through our social, scientific and economic progress, human life has been strengthened and prolonged. In ancient Greece, life expectancy at birth was 20 years of age. By the 1700s, life expectancy had only increased to 30 years of age. In 2008, just 300 years on, half of all baby girls being born in Ireland are expected to live to 100 years of age and beyond. Our longevity is something to be celebrated. The Government recognises this and is committed to supporting older people. This is reflected in the current social partnership agreement, Towards 2016.
In the agreement the Government and the social partners have adopted a life cycle perspective, placing the person as the centrepiece of social policy development. The vision for older people, as reinforced in Towards 2016, is to provide the support, where necessary, to enable older people to maintain their health and wellbeing, as well as to live active and full lives, in an independent way in their own homes and communities for as long as possible.
There are specific initiatives for older people in the partnership agreement, such as pensions and income supports; housing and accommodation; community and residential health care; mobility; and promoting education and employment opportunities. The high-level objectives of these initiatives, individually and in combination, are intended to make a real and significant improvement in the quality of life of older people.
A new nursing homes support scheme, in the fair deal legislation, is going through the Houses at present and was approved by Government and originally announced in December 2006. The Bill providing for the scheme was published on 9 October 2008 and is on Second Stage in the Dáil. The Minister intends to introduce the new scheme in 2009.
The fair deal legislation is designed to remove real financial hardship from many individuals and their families who, under the current system of nursing home subvention, have to sell or re-mortgage homes to pay for the cost of nursing home care. There will be one transparent system of support towards the cost of care that will be fair to all, irrespective of whether they are in public, private or voluntary nursing homes.
The scheme will equalise State support for public and private long-term care recipients. This will meet one of the objectives of Towards 2016, namely, that State support should be indifferent as to whether a person is in public or private care. At present, the State pays an average of 90% of the cost for people in public nursing homes. In contrast, the State only meets approximately 40% of the estimated average cost of care in a private nursing home and some people have to sell or mortgage their homes to meet their care costs. In some cases people receive no State support whatsoever. The scheme aims to render private long-term care affordable and anxiety-free, and ensure that no one has to sell their home during their lifetime to pay for their care.
The current standards for nursing homes are set out in the Nursing Home (Care and Welfare) Regulations 1993. The HSE inspects private nursing homes on the basis of these standards, but public homes are not inspected. The Health Act 2007 provides for the registration and inspection of all nursing homes, public, private and voluntary. It provides for future inspections to be carried out by the chief inspector of social services, part of the Health Information and Quality Authority, HIQA. The existing inspection and registration systems for residential services will be replaced by a strengthened and expanded system.
In 2007, the Minister for Health and Children published a new set of draft national quality standards for residential care settings for older people. The standards, when approved and underpinned by regulations, will replace those set out in the Nursing Homes (Care and Welfare) Regulations 1993. Importantly, the new standards will apply to all residential settings, public, private and voluntary, where older people are cared for and for which registration is required.
The draft standards are designed to ensure the protection of residents, to safeguard and promote their health, welfare and quality of life and to ensure that there is a focus on the well-being, dignity and autonomy of older people. As the Health Act 2007 provides that the enhanced inspection function will be taken over by HIQA, the draft standards were formally referred to the authority for consultation and finalisation. HIQA established a working group to finalise the draft standards which included public consultation.
Earlier this year, the HIQA board submitted its final draft national quality standards for residential care settings for older people to the Minister for Health and Children for her approval, as required under the Health Act 2007. Regulations will be introduced to underpin the standards and at the moment the Department is in the process of carrying out a regulatory impact analysis, RIA, on them. As part of this process, we commissioned an independent consultancy to carry out a cost-benefit analysis on the financial impact the standards will have in long-term residential settings. Consultation with stakeholders is also a part of this process and on Thursday, 23 October 2008, the Minister for Health and Children, Deputy Harney, and I hosted a consultation session on the draft standards. Many of the key stakeholders were present and it offered them an opportunity to feed into and inform the RIA before finalisation and to discuss the standards, their criteria and proposed regulations in advance of their introduction.
A comprehensive policy vision requires a comprehensive, cross-departmental approach to policy development and delivery. The establishment of the Office of the Minister of State with responsibility for Older People in January of this year will bring coherence to Government planning, policy and service delivery for older people. This office encompasses three Departments. As Minister of State with responsibility for older people, I also have responsibilities in the Department of Social and Family Affairs and in the Department of the Environment, Heritage and Local Government. I am also a member of the Cabinet committee on social inclusion which ensures that there is an integrated coherent approach to issues relating to older people across Government level. This approach is crucial to delivering the Government's vision of improved integration of services, and thereby further supporting older people in the future.
My office will also continue to develop health policy and will oversee and monitor the delivery of health and personal social services for older people, and the running of the long-stay charges scheme. It will, in short, be the focal point for the development of a more comprehensive policy on older people. The resources of my office, which is currently staffed by officials from the Department of Health and Children, will be strengthened shortly by the addition of the staff of the National Council on Ageing and Older People. These new staff will significantly add to the research and overall capacity of my office.
The voluntary sector in general will also make a positive and essential contribution to the development of policy on older people. This will be primarily through the establishment of a new national advisory council on older people. One of the main functions of this new advisory council will be to advise me, as Minister of State, on all aspects of the lives of older people. The council will also suggest ways of better co-ordination and delivery of services for this sector of society.
The establishment of the office, the inter-departmental network and the advisory council will bring a greater coherence to policy-making for older people. These significant new measures will allow for a much greater degree of cross-cutting and will further develop the partnership approach that has featured so strongly in the planning and development of services for older people in recent years.
Co-operation between Departments and agencies and relevant stakeholders is essential if the provision of services, supports and entitlements for carers is to be fully addressed. The area of carers is of particular interest to me as Minister of State with responsibility for older people. As Members are aware, we are developing a national carers strategy. An inter-departmental working group, chaired by the Department of the Taoiseach, was set up to progress the issue. The Departments of Finance, Enterprise, Trade and Employment and Health and Children, the Health Service Executive and FÁS are also represented in the group. The development of the strategy also involved a wide-ranging consultation process, including meetings with the social partners, the carer representative groups and a written public consultation process earlier this year. The strategy will focus on all informal and family carers in the community and not only those in receipt of a social welfare payment. It is hoped that the strategy will be finalised shortly.
Within the EU member states, Ireland stands out as having a relatively youthful population. While we are undoubtedly on the same demographic path as our EU counterparts, we are still some way behind. The latest statistics tell us that 11% of people living in Ireland are aged 65 years or over. It has been estimated that this figure will rise to 20% by 2036, and to 29% by 2056. Thus, an opportunity exists at present, while our nation is still young, for us to carefully plan ahead. This opportunity has been recognised by Government and manifests itself, in particular, in two key commitments, namely, the development of a strategy for positive aging and a future funding model for long-term care.
I am pleased that one of the key functions of my office is to develop a strategy for positive ageing. The new strategy will be developed on a cross-departmental basis. My goal is to ensure that this strategy is meaningful and innovative and that it will result in real improvements in the lives of older people. The strategy will involve, for example, the development of operational plans by Departments, clearly setting out objectives relating to older people, and joined up thinking on initiatives serving this community.
Other areas for consideration include ongoing mechanisms to monitor progress and to identify challenges. As I said, the policy vision outlined in Towards 2016 requires a comprehensive cross-departmental approach. It also requires sustained and sustainable levels of funding. The substantial funds allocated by the Government to services for older people in the last three years is a testament to its commitment to the principles outlined in Towards 2016. In 2006 and 2007 alone, more than €400 million was provided to enhance service developments throughout the sector, of which more than €165 million was for community based services. A further €25 million was provided in 2008 and funding levels for community services were maintained in the recent budget.
To underpin the objectives in Towards 2016, the needs of older people were specifically highlighted in the social inclusion element of the National Development Plan 2007-2013. Some €9.7 billion will be invested under the older people's programme, with €4.7 billion allocated to the living at home sub-programme and €5 billion to the residential care sub-programme. The Government is firmly committed to using the national development plan as a vehicle to translate policy into practice over the period of the plan.
I propose to share time with Deputy Perry.
Is that agreed? Agreed.
As a Member of this House for more than 11 years, I can honestly say this is the most reprehensible and repulsive legislation that has come before us in that time. We are accustomed to spin from the Government but to find that the parliamentary draftsmen have been brought into the dishonest portrayal of these proposals is disappointing. The explanatory memorandum refers to the Bill as providing a new "scheme for entitlement to medical cards". The reality, however, is that it introduces a scheme for the removal of that entitlement. It is dishonest to pretend otherwise. I cannot recall any measure that has caused so much distress and upset.
Apart from the distress it has caused, it has also come as a shock to older people who, in planning their retirement, factored into their budgets the expectation of a medical card. These are people who were careful and who planned for the future. Now they find those plans, perhaps built over many years, are in tatters. Within the space of a few months, they have endured several attacks. Not only are their medical cards withdrawn, thus leaving them to find money for health bills they never expected to face, but they are also discovering that their pensions are not worth a fraction of what they expected and of what they contributed. Moreover, any savings will be affected by the fall in interest rates to almost nothing. Dividends on investments they may have made are reduced if not cancelled for the foreseeable future.
Whatever about frustrating the expectations of those who assumed they would receive a medical card next year and in the following years, nobody, on either side of the House or outside it, imagined the Government would take medical cards from those already in possession of them. This is being done not to millionaires but to 80 year olds, 90 year olds and 100 year olds. We heard all the claptrap about how millionaires do not deserve medical cards. There is no denying that and I fully agree that such persons should not be eligible for them. However, it is not they who are losing medical cards. For the most part, millionaires who were eligible never bothered to claim them. It is middle Ireland — compliant, tax-paying, hard-working former employees — who will lose out. Now, in old age, they are left to worry about how they will pay their medical bills. Teachers, nurses, gardaí, civil servants and their middle-income counterparts from the private sector will struggle without the medical cards they were promised by the Government.
We can be certain that from 1 January 2009, as has happened in the past, elderly people will avoid visiting their GPs and renewing prescriptions because they simply cannot afford to do so. Even if they can afford it, it may be their perception that they cannot. Older people are fearful of the future and careful with their money. If they believe they cannot afford to pay for medicines, they will stop taking them.
I spoke today to a former assistant principal who went on to work in the Dáil until recently. This person will lose her medical card next year. Single people are particularly penalised by the new system. It has always been the case that two people can live more cheaply than one. To set the single income threshold at half that for couples is particularly punitive for single individuals. In the case of two neighbouring households, for example, one occupied by a single person and the other by a couple, the overheads will be exactly the same. If nothing else is done, this at least should be reviewed.
The Minister seemed to assure us when this proposal was announced that the eligibility limits would be index linked. We now discover this is not the case. This is another example of the dishonesty shown to the public. Everybody understands that the money is gone, that the cushion we should have had against a global recession was spent foolishly and in a flathúlach fashion. However, there must surely be something left for our elderly. Surely at least those already granted a medical card should be allowed to retain it for the remaining years of their lives. Surely those who expected to receive a medical card this year or next could be granted at least two free GP visits per year or free medicines. Even a small flat charge for GP services would be better than nothing.
However, no effort has been made to provide any such concessions. Instead, the individuals concerned will have to pay the full cost of their primary medical care. Moreover, there is a double whammy in that tax relief on medical expenses will only be available at the standard rate. The elderly have been given one slap in the face after another, with no attempt made to negotiate with GPs. We were told the existing scheme was too expensive and that GPs were making considerable sums out of their participation in it. However, no attempt was made to renegotiate existing arrangements with GPs or to move to the provision of generic medicines. Instead, it was easy to use elderly people as leverage in seeking a new deal.
Eligibility is calculated with reference to gross income, including income from savings, dividends and so on. Never has such income been more volatile. A situation will arise where individuals will be eligible for a medical card one year but not the next and so on. Nobody, particularly elderly people, can plan their budgets on the basis of such uncertainty as to entitlements. They will live the remainder of their lives in fear and uncertainty, not knowing whether they need to pay health insurance in any given year and whether they can afford to put heating oil in the tank. This is unacceptable.
The entire thrust of the philosophy of the Minister and the Health Service Executive, as referred to again today by the Minister, is to move away from hospital care and towards care in the community. The aim is to keep people healthy and out of hospital by ensuring they have access to GP services so that illnesses are detected early and there is early intervention and treatment before the need for hospitalisation arises. That was the thinking behind the universal provision of medical cards for over 70s. In addition to early intervention, follow-up physiotherapy, dressings and so on were to be available to them free of charge. It is proven that this provision improved the quality of life of people over 70 years of age. In addition, there was a substantial saving for the State arising from the reduction in hospitalisation charges, which cost a minimum of €1,000 per day.
Older people are more frequently ill and need to consult their GP more regularly than younger people. The loss of a medical card to an elderly person is twice the burden it is for a younger individual. This greater financial burden on older people must be recognised. We must acknowledge that older people fear the future in a way that younger people do not. They will husband their resources and may decide, if they feel unwell, to wait one more day before seeking medical attention, then another day and so on until it may be too late. The promise of primary care investment is just that, another false promise. Nobody can have faith in a system or a Government that is built on ever shifting foundations, where principles expounded one day are cast out the next, a system where there is no consistency, logic or humanity. If somebody who loses their medical card faces huge medical bills, what are they expected to do? We are told by the Minister that the HSE will have discretion and will use it. Everybody knows what discretion for the HSE actually means. It is resource and time related. If somebody contracts cancer in January, they might receive a medical card, but if they contract cancer in July, it will be tough luck. That is the reality of the HSE's discretion. That was the case this year; God knows if it will even have that much discretion next year.
The killer blow to the elderly which will ensure they will have even less disposable income after they pay their medical bills is that they will also have to pay the Lenihan levy. A person whose income is at the threshold where they do not meet the eligibility criteria for the medical card will pay a minimum levy of €3,650 from that disposable income. If the person has been prudent and saved their money to provide for their future, they will pay even more because they will have to pay the levy on savings and investments.
As a final straw, it was reported in today's newspapers that there would be a concession by the Minister. In the legislation, as published, if widows and widowers had an income of slightly over €700 following the death of their spouse, the single person's eligibility level, they would lose their medical card. The big concession is that the Minister will wait until they are three years older before taking their medical card. It is breathtaking in its pettiness, total lack of compassion and meanness of spirit. It is unbelievable a Minister would suggest this. If I were the Minister of State, I would claim I had nothing to do with it. It is an absolute disgrace to even think of it.
I wish to deal with two further issues. The elderly must now attempt to take out private medical insurance again, that is, if they can get it and all their existing conditions will still be covered. They will also have to pay more because there is a levy. The Minister presides over the sale of this product. I have never previously seen a case where the introduction of competition in the sale of a product or service meant the price increased for everybody. That defies all understanding.
Where older people have lost their medical card, are unable to be kept in their homes and discover they must go into a nursing home, they will have to pay the full cost of that nursing home care under the new regime. The fair deal is fair to some, but those with savings and who are losing their medical card will not benefit from it.
Why not?
It is because they have savings. They must outlive their savings in the nursing home before they will gain any benefit from the fair deal. Even then, they have also lost the subsidy that was available to them previously. The final straw is that the tax relief they might have claimed is now down to 20%. Shame on the Minister and shame on a Government that would think of introducing a measure such as this.
The Deputy should check the facts. That is not true.
When all the facts come to light, it is exactly true.
I thank Deputy Mitchell for sharing time. When contributing to the Second Stage debate on new legislation, it is the normal expectation Deputies would speak to the detail of the Bill. However, in the case of this legislation from the Minister, Deputy Harney, I call on the Government to withdraw the Bill and start again. To paraphrase the old adage, given where the Government wants to get to, this is the wrong place to start. Even at this late stage it is not too late to correct this mistake.
The introduction of a universal automatic entitlement to a medical card for the over 70s was announced with great fanfare by the previous Fianna Fáil Taoiseach. Perhaps he wanted to cement one good deed into history with a grand gesture to rival the introduction of free travel for pensioners by a previous Fianna Fáil leader, the late Mr. Charles Haughey. In the Bill before the House the principle of a universal automatic entitlement to a medical card for the over 70s is being deconstructed by the Taoiseach and the Minister. Even worse, it is being deconstructed in a way that is vague and sees the reintroduction of means testing. Worst of all, the number of pensioners to lose their medical card will be relatively small. With all the resources at the Minister's disposal, is this Bill the best option she can choose to achieve some minimal short-term cash savings which are decreasing by the week? Did she not consider any other options?
When the Minister started this review, she could have examined the demographics and other statistics to find an age somewhere between 70 and 105 years, for example, whereby she could still preserve the principle of a universal automatic entitlement to a medical card. The Fianna Fáil Government should have been able to find an age bracket that would ensure the entitlement was preserved for some age band of pensioners. The fact that the Minister did not do this suggests the Bill is the precedent that removes the automatic entitlement for a starter group of pensioners and that the age selected and the flexibility in the means test protocol will be used to gradually expand the band of pensioners to be excluded from entitlement in future years. Cutting off entitlement to the medical card for a small number of older people now, approximately 20,000 according to the Minister's estimate, does not make any sense, unless the real agenda is to gradually exclude more in the future.
Having abolished the universal automatic entitlement to a medical card for the over 70s, the Minister seems to have had second thoughts and has now introduced a new three tier system of entitlement for the over 70s. One category is those who can receive a medical card based on an assessment of their financial circumstances. A second category is those people over 70 years whose income is above the specified income limits but who can apply to the HSE for a discretionary medical card on the basis that their health circumstances cause undue financial hardship. The third category of people over 70 years will be denied a medical card under the terms of the Bill.
Current medical card holders over the age of 70 years will have to make a voluntary declaration to the HSE by 2 March next year if their income is above the thresholds. People who turn 70 years after next January and who do not have a medical card will have to undergo what the Department of Health and Children describes as a simplified means test to establish that their income does not exceed the threshold. Perhaps the Minister would explain what is meant by "simplified", because it is far from simple when the application is being processed. The Bill provides for a complex bureaucratic calculation protocol covering gross income, including income received through pensions, interest on investments or savings, rents from property and income from part-time employment. All of this is to be done on the basis of a voluntary declaration by the pensioner.
The signals from the Bill are that people who worked hard all their lives, made a success of their career, achieved a good standard of income and managed to save a good lump sum for use in their declining years are now to be penalised by the State. In their years as pensioners they are to lose out in comparison with others. This is not fair. Effectively, the Bill provides for an honour system of voluntary declaration on the means test protocol. I will agree with the Minister on one point, that, by and large, those who are likely to lose their entitlement to a medical card are people of personal honour. All their lives they were model citizens, independent and responsible, earning their living, paying their taxes and saving for the future. Furthermore, we must not forget that even as pensioners they are still paying taxes. These people are more deserving of a universal automatic entitlement to a medical card than many others. If the country cannot afford the automatic entitlement in these more difficult economic times, I propose that the Minister consider the concept of retaining the universal automatic entitlement to a medical card and asking these citizens to make a moderate annual co-payment as an alternative way to cover the budgetary gap.
I believe in the principle of universal entitlement to a medical card. I was Chairman of the Committee of Public Accounts when this proposal was introduced in 2002. The advice was given to the Minister at the time but the calculations by the Department were totally inaccurate. The universal entitlement to a medical card was introduced in an attempt to win the 2002 general election.
People are taxed throughout their working lives and through the probate system. Many have made a considerable contribution, have half pensions and are still paying income tax. In many cases, the only benefit they receive is the reassurance provided by a medical card.
Many people have lost substantial savings. In recent weeks, I heard of a case of a senior citizen with a large shareholding in the Bank of Ireland whose savings declined in value from hundreds of thousands of euro to less than €100,000. This person is so concerned and experiencing such stress that their life expectancy is likely to have been shortened considerably.
A large number of independent elderly people who are not supported by sons or daughters live in private nursing homes at their own expense. The value of shareholdings and investments has declined as a result of the current financial debacle, while State investment in pensions is declining daily. Many people invested privately in blue chip companies having been given the impression by the Government that these companies and the banks were the best places to invest. Their investments are now worth very little. In the past year, for example, the value of Bank of Ireland shares has declined from €18 euro per share to slightly more than €1. I appeal to the Minister to reintroduce an automatic entitlement to a medical card for those aged 70 years and over. This is the least those in their senior years should expect.
I will share time with Deputy Beverley Flynn.
I thank the Ceann Comhairle for affording me an opportunity to contribute on Second Stage of the Health Bill 2008. The issue of medical cards for elderly people has been most emotive, with many people fearing that all medical cards would be taken from those aged over 70 years. Such a step was never intended. Hearing people from my parents' generation cry, worried and fearful, on radio shows made for tough listening. The real fear of many people was on display at the protest on Kildare Street following the budget. However, I am reminded of how quickly times change given that in 2001 Opposition Deputies had no appetite for the introduction of medical cards for those aged 70 years and over.
Under the new system, the Health Service Executive will write to all medical card holders aged 70 years and over informing them about the new arrangements. People whose income is below the new threshold will keep their cards and continue to use them as normal. Only those whose incomes are above the threshold will be required to notify the HSE. If a person's income is below the limits, he or she will not have to wait on a letter to arrive and should not be worried or fearful. Such persons can rest assured they will keep the medical card. This vital information, which was lost in the debate, needs to be reiterated.
The new income thresholds are designed to ensure that the vast majority of people aged 70 years and over will continue to have a medical card and only those on higher incomes will lose their entitlement. The new income thresholds announced by the Government for persons aged 70 years and over mean that from 1 January 2009 onwards, retired Ministers, Ministers of State, judges and Secretaries General of Government Departments, to name but a few, will no longer qualify for a medical card. Should such individuals receive a medical card? Individuals in these groups earned enough money in their working lives. Medical cards would be better placed in the hands of ordinary men and women who earned a modest wage during their career or do not have a substantial pension.
Deputy Jan O'Sullivan asked the reason gross income is used as the threshold. Income is any earning a person receives in the form of a pension or through investments or savings. Under the scheme, gross income is assessed, that is, income before tax or other deductions. It is much easier to identify what is one's gross income. The new gross income thresholds are well in excess of the net limits of €360 and €720 for a single person and couple, respectively. Previously, those whose income was less than these thresholds would only have qualified for a GP visit card.
It should also be noted that only the interest earned on savings is counted as income, while income from savings up to the first €36,000 for a single person and €72,000 for a couple is not counted. However, those whose income is over the threshold may still receive a medical card if their personal or health circumstances cause them undue financial hardship. In the event that one partner is aged 70 years, both partners will qualify for a medical card if their income is less than €1,400 per week. In addition, the current HSE appeals mechanism will continue to apply.
There will always be pressing demands on scarce national resources. It would be a wonderful world if everyone received free medical care but unfortunately we do not live in such a utopia.
Denmark is such a utopia.
We must target resources at those who need them most. It is important we devote scarce resources — taxpayers' funds — to meet the needs of those who most require health services. Anyone with income above the threshold who has difficulty meeting his or her medical needs will be eligible to apply for a medical card under the Health Service Executive's discretionary card scheme.
The new arrangements do not require those currently eligible for a medical card to undergo a means test. Everyone aged 70 years and over will be notified of the new arrangements and only those with incomes above the new threshold will be required to notify their circumstances to the HSE.
I sincerely regret that the issue of medical cards has been a cause of major concern. I received many calls from concerned individuals in the days following the budget. I hope the new arrangement will reassure people that the Government is concerned about their status. The vast majority of people will be eligible for a medical card under the new income limits. Only those at the top of the income bracket will not qualify for a card.
A process of intense engagement with the Irish Medical Organisation and those with particular expertise in this area was established to develop recommendations for good practice which will secure safe and effective prescribing for patients, while maximising the potential for the economy in the use of public funds. Headed by Mr. Eddie Sullivan, the group recommended a new single capitation fee of €290 which the Government intends to implement from 1 January 2009. The new medical card application form will be much simpler than the current form which is long, detailed and difficult to read, appraise and complete. We are leading longer and healthier lives, for which we should plan prudently and wisely.
Like many of my colleagues, I contacted the Minister to express the concerns of widows and widowers. I am pleased she will introduce an amendment to address this issue.
I do not agree with Deputy Olivia Mitchell that people will stop taking their medications. Such a course of action would be a retrograde step. I appeal to all sides not to add to the hysteria we observed.
As my colleague, Deputy Bobby Aylward, indicated, a media frenzy was whipped up on the issue of medical cards for the elderly and numerous people developed a new found interest in care for the elderly as they sought to use an opportunity to oppose the Government. While the Government made an initial error in setting income thresholds, we were strong and humble enough to listen to people. Accordingly, the income thresholds were adjusted upwards. The Government will continue to honour its commitment to older people who made a valuable contribution to our country. I commend the Bill to the House.
I welcome the opportunity to speak in the debate. The record of the Fianna Fáil Party on services for the elderly during the 11 years I have been a Deputy is a proud one. I am particularly proud to have been a member of a party that increased pensions to their current substantial levels. In 2001 when the universal medical card was introduced for the over 70s I saw it as recognition for people in the latter days of their lives who worry very much about their health and as a very positive development at the time.
As everybody knows we are now in different economic circumstances and it is difficult to make decisions of this type. This one was particularly difficult and I, like all other Deputies in the House, received hundreds of phone calls from constituents who were very concerned. At the time they were concerned because there was a lot of misinformation and inadequate information in the public domain. When I contacted the hundreds of people who made contact with me and explained the new thresholds to them, all but a few cases were covered by the new threshold limits and people were satisfied.
The initial worry and concern imposed upon people is regrettable. I apologised on my local radio station for the concern caused to many people who should not have had to go through that. I am conscious of elderly people and as a Deputy I have spent a lot of time over the years handling the queries of elderly people and going to active retirement meetings. They are a group of people I have always been very careful to try and look after to the best of my ability.
We must point out the realistic features of the Bill. The most important one is that 95% of all people over 70 will continue to have a medical card, and that cannot be highlighted enough. Of the people who contacted me, in all but a few cases they qualified for a medical card. I am happy the Bill makes allowances for people who are now 70 or will be 70 before 1 January. It puts them in a position where, if they are below the income threshold, no further action on their part is required. They will be entitled to use their medical card after 2 March, do not need to communicate with the HSE and business continues as normal. The vast majority of people who contacted me fell into that category.
Those who currently have the universal medical card but, will now be above the income threshold, will lose their medical card after 2 March. That is regrettable, there are scarce means available to us now and few people are affected. There are 350,000 people who are 70 and over, and of these approximately 330,000 will retain the medical card after 2 March. It is important to highlight that and not worry people unnecessarily.
Many questions were asked in the House on why the means test applies to gross income. It is important the means test be kept as simple as possible and it is something for which the Minister has made allowance in the Bill. It is simple in that gross income for a single person applies at the amount of more than €700 and more than €1,400 for a married couple. Dealing in gross income allows for a simple means test and is something about which I am happy.
Those who turn 70 in the new year and whose gross income falls below the new threshold will apply to the HSE and will receive their medical card after the simple means test. Those whose income is over the threshold will not be eligible. However, there are a number of categories. In addition to the new income thresholds the discretionary card is also available. It is something I have used extensively in my constituency over the years, based on medical information.
People over the age of 70, as has been referred to by a number of Deputies, tend to become ill more and have serious health issues, and special cases can be referred to the HSE to enable such people to get a discretionary card. I will ask the HSE to deal in a fair and balanced way throughout the country with all those who apply for the discretionary card. I would like to see as many people as possible eligible for it. People can also apply under the previous net means test, which is a third option. Those that do not qualify on any of those grounds can benefit from the drugs payment scheme, which ensures no individual or family unit has to pay more than €100 for drugs or medicines each month.
There have been many references made to investments and a Deputy mentioned that investments at the present time are very volatile. A single person can still have investments of €36,000 or a married couple €72,000 which are completely disregarded. Only the income or interest from savings above those figures will be considered for a means test. In a time of low interest rates, this enables people to have a substantial amount of money on bank deposit and still be in a position to qualify for a medical card.
There are many people, even within my constituency, who have emigrated over the years and have built up a nest egg for their old age. I am conscious of this as I dealt with people who had money to invest in my previous career. These people need this money; it is a cushion and a safety valve for them. Many of them will never spend their money but they have worked very hard to be able to put a few pounds away. It is important that those in a position to have some savings are not at a disadvantage in dealing with their medical card. The income thresholds set for savings represent a fair amount of savings for a married couple or a single person, without it being taken into consideration. I welcome the inclusion of this in the Bill.
I also welcome the annual review of income thresholds to take into account cost of living increases over the lifetime of this Government. I am concerned that 95% of people — the best estimate available to the Department based on the figures available — will qualify. It will be important over the coming years to keep the income thresholds at a level to maintain the 95% figure throughout the lifetime of the Dáil.
There are many quotes from Members of the House, even dating back to the Labour Party document in 2004 where reference was made to medical cards to over 70s. It stated that those over 70 do not qualify on income grounds and are the highest earners in that category. People from both sides of the House referred to the fact that those over 70 were not being means tested and perhaps the money might be better spent, and spent in a more equitable way. They said that no-one wants to see millionaires with a medical card.
We are in very tight economic circumstances. We all know families with young children and want to see the resources available directed to where they are most needed. I have found the issue of medical cards for the over 70s very difficult and do not pretend that it was not difficult for every Deputy. It is always difficult when one has something and it is taken away. Giving something in the first place is always good news, and in 2001 it was very good news. It is a difficult situation and has happened because of the economic circumstances we find ourselves in. The income thresholds, as they are currently set, with a provision for savings, represent a fair mechanism whereby the vast majority of people will qualify for a medical card.
I felt the fees paid to GPs in the past for participation in the universal medical card were unacceptable. The average person I discussed this matter with over the last number of weeks and months was shocked when they became aware of the amount paid to GPs for a person who availed of the universal medical card. Maintaining that level of fees was unsustainable. I welcome Mr. Sullivan's recommendations on the new single capitation fee to be paid to GPs for medical cards for the over 70s, which at €290 is fairer than the €640 paid heretofore. When that is compared to the fee paid for a person availing of a means tested medical card people did not find it acceptable. Members on both sides of the House recognised that point.
One positive development concerns men over 70 lucky enough to be married to women who are 65 or younger — the reverse is probably not as common. Because they are availing of the higher thresholds, many younger women who did not qualify for a medical card in the past will now benefit. I made this point on radio in the last number of weeks and received a significant response. There are many people who will enjoy a medical card for the first time because of the higher thresholds. In making that point I ask the Minister to examine the issue. I have heard the point made by Members of the Opposition about widows. While some are now receiving the medical card because of the new system in place, a widow who is slightly above the €700 threshold may not qualify. The Minister should re-examine that issue. We should be compassionate in the decisions we make. I do not believe it was the intention of the Minister to subject people to hardship when she removed universal entitlement to the medical card. It might be possible to look at this issue in the Bill at a later stage, especially when there is a category receiving medical cards who did not previously enjoy them.
I commend the Bill to the House and look forward to the matter being discussed on Committee Stage.
I wish to share time with Deputies Sherlock and Ó Caoláin.
In listening to this debate, in particular to the contributions of the Minister and the three previous speakers, one would imagine that we were introducing for the first time new limits for people aged over 70 years. That is not the case. We are withdrawing the medical card from 20,000 people aged 70 years and over. That is not a small group. Some 20,000 people who have enjoyed the medical card until now will no longer have that luxury. It will be withdrawn on the basis that the Government wants to save money. That is outrageous.
The last contributor stated it was amazing that a younger woman married to an older man would now enjoy a medical card, even though she had not reached the age of 70 years. That was the case before the Bill was introduced and she would not have had to worry about being means-tested when she reached 70 years. It was as if this was a great Bill which was conferring benefits on people they did not already have. However, they already had them, as they were conferred on them by legislation. We are now withdrawing them. It is outrageous to suggest only millionaires will be affected. I do not know if any of us has ever sat in a doctor's surgery next to Tony O'Reilly or Michael Smurfit or their wives. They are probably the only ones who can get doctors to make house calls these days. We are talking about schoolteachers, gardaí, nurses and persons who have paid their contributions and ended up with a pension that is reasonable. We were told by the Government to ensure we had pension cover that would be sufficient to sustain us in our old age. God only knows where these pension funds are now, but that is what we were told to do. I doubt if Michael Smurfit has applied for a medical card. We are talking about civil servants, teachers, doctors, nurses and gardaí.
The luxury of having a medical card was that it provided security. If we could bottle that sense of security, we would never lose our seats. It was about providing security in a person's old age and ensuring the roof would not fall on top of him or her. If a person got sick, he or she would have the luxury of being able to go to the doctor.
The second last contributor told us that we did not live in utopia, that it was only in utopia that people were completely covered in respect of their health needs. That is not true. In most civilised European countries there is a womb to the tomb policy in the health service which is paid for from the public purse and when times get hard, as they have in other countries, vaccines that can save a woman's life are not withdrawn, nor are medical cards from the elderly. Governments all over the world find other methods of making savings and to live up to their responsibilities. However, the Government has decided that the two groups to be hit the hardest are young girls and the elderly.
The Minister has told us we will live longer and that a baby girl born today has the possibility of living to be 100 years old. That might happen if she does not have cervical cancer, but the possibilities of contracting cervical cancer have been greatly increased as the vaccine will not be supplied. It is outrageous that the Government and backbenchers should come into the House——
The Deputy's time has expired.
Backbenchers did not bring about this U-turn, nor did the media frenzy. The outrage of elderly people on the streets hounded the Government into making this decision but is not enough. We will come back to it.
The amendment in the Bill that replaces section 45(5)(a) of the Health Act 1970, coupled with the fair deal legislation on nursing homes, by their very nature, seek to destroy any semblance of public provision and universality in the health care system, as it relates to older people. The research indicates that 20,000 people who have had access to a medical card will no longer have such an entitlement. This sends the wrong message about how the country deals with public health to those who are in their autumn years. Notwithstanding the pre-existing deal done with general pracititioners, whereby the payment per patient would be significantly more than it is today, the health outcomes for patients in that category were significantly better as a result of having a universal right to a medical card. For men, in particular, having the medical card meant a much greater likelihood that they would go to their GP to monitor their health. I know of people in my constituency who were more inclined to go because they had the medical card. From talking to GPs, I also know that they achieved far better outcomes for their patients owing to the entitlement to a medical card. When we talk about public health and primary care provision which is woefully inadequate in the part of the country that I represent, I do not understand why the Minister would row back on a decision made to provide a medical card when the net benefit to the Exchequer is positive in terms of improved health outcomes because it keeps people out of secondary and tertiary care facilities.
Fianna Fáil backbenchers spoke about hysteria and the media frenzy whipped up over this issue. The people who marched on Leinster House were not whipped up into a frenzy of hysteria. At the time they took the rational view that their rights were being undermined. They were rightfully fearful of the possibility that their entitlements would be taken from them in one fell swoop. I am glad they decided to organise and exercise their right to protest. If they had not done so, we would not be here today and the Government would not have rowed back on the position it took on this issue on budget day. If we are to exercise public health policy correctly, it is clear that the campaign to maintain the automatic right to a medical card will need to have a positive outcome. We need to continue in that vein. I do not see how the Minister will be able to garner savings in this instance. It seems that she intends to reallocate resources from those whose automatic entitlement is being withdrawn to others who might be able to avail of a medical card. People on lower incomes will not receive a medical card in the current climate because the thresholds have not been increased sufficiently.
I move amendment No. 1:
To delete all words after "That" and substitute the following:
"in view of the fact that the Health Bill 2008,
removes automatic medical card eligibility for people over 70,
reneges on the commitment in the Programme for Government agreed between Fianna Fáil, the Progressive Democrats and the Green Party in 2007 to extend medical card eligibility,
represents a further step away from universal access to public health services based on need alone,
Dáil Éireann declines to give a Second Reading to the Bill."
Molaim an leasú i m'ainm ag cur i gcoinne an Dara Léamh den Bhille Sláinte 2008. I have proposed that the Dáil should decline to give a Second Reading to the Health Bill 2008. Sinn Féin is totally opposed to the Bill because it seeks to implement one of the most callous, ill-considered and bungled decisions ever made by a Government. Some years ago, with great fanfare, a Fianna Fáil-led Government gave everyone over the age of 70 years an automatic entitlement to a medical card. It never ceased to boast of the benefits it had provided for older people, of which this was the centrepiece. In the rushed budget the Government revealed once more that much of its policy was underpinned by a fundamentally flawed approach that saw vital public services not as rights but as benefits or favours that could be given and taken away at will. The pretext for the removal of the automatic medical card entitlement of those over the age of 70 years was that it was a cost-saving measure. Like the Government, we do not yet know what savings, if any, will accrue from this decision. A massive wave of protest from older people forced the Government to modify the measure. Its actions exposed the ill-considered nature of its original decision once more.
The Government has introduced a new payment for general practitioners of €290 in respect of all medical cards, including medical cards held by those over the age of 70 years. It did this in the shortest time possible because it was facing massive political pressure. It is clear that it did not have the political will to reset the fee before it made its bungling decision to end the automatic entitlement to the medical card of people over the age of 70 years. The debacle exposed the appallingly bad deal for the taxpayer that the Government had negotiated when it first introduced the entitlement of people over the age of 70 years. It allowed a far higher fee of €640 to be paid in respect of those entitled to the medical card by virtue of age alone. Similar confusion persists in respect of the new €290 fee. The Irish Medical News reports this week that the Department of Health and Children is unable to answer its queries about how the new fee will be introduced. It states three months notice is required to terminate the current GP contract that applies to those over the age of 70 years. I presume this means that the old fee will apply for three months after the Bill is enacted. Is that the case? I ask the Minister of State, Deputy Michael Kitt, to clarify this matter.
On the issue of costs and savings, the Minister said in the Seanad on 29 October last that the number of people over the age of 70 years who were in receipt of a medical card exceeded by 10,000 the number over the age of 70 in the State. She explained this anomaly by saying it "probably" had resulted from "people have passed away" continuing to be "factored into the equation". It is a damning indictment of the Minister, her Department and the HSE that, for all their bureaucracy, they are unable to ensure GPs are not paid medical card fees in respect of thousands of deceased patients. I agree with Age Action Ireland which has pointed out that "By improving the administration of the system and taking medical cards from the dead rather than the living, (the Government) can make half its targeted savings and ensure the economic running of the scheme for all older people".
Similarly, the Government should listen to the words of the chairperson of the Irish Society of Physicians in Geriatric Medicine, Dr. Shaun O'Keeffe; the president of the Irish Gerontological Society, Professor Des O'Neill; and the President of the Irish Association of Social Workers, Ms Ineke Durville. In a joint statement they warned of the impact the loss of the medical card entitlement would have for people over the age of 70 years. While they welcomed the changes made by the Government to the initial budget proposals, they said they remained concerned about those who would lose their entitlement to a medical card:
Free access to GPs facilitates preventative, as opposed to therapeutic, visits. Older people are the most likely to suffer from chronic disease. Optimal management of these conditions emphasises the importance of timely and frequent use of primary care to reduce personal suffering and societal health care costs, including costly hospital use. Since the introduction of the universal over-70 medical card, the first Irish longitudinal study on ageing — Health and Social Services for Older People II — showed a major increase in preventive healthcare uptake in the over-70s.
The three senior health and social service professionals in question pointed out that the loss of the medical card entitlement would involve the loss of services needed to keep older people with chronic illness in their own homes such as forms of medication and therapy and appliances like special beds and chairs. As social services are underdeveloped and home care packages are means-tested, people with annual incomes of up to €36,500 can find themselves financially challenged when they try to provide the supports needed. The three people mentioned argued:
Means-testing is a psychological and administrative barrier. It will erode the benefit of the scheme and probably cost more than providing the medical card to the minority of affluent older people who want one. Moreover, it is not only a matter of having enough money to pay for private care: for many, possession of the medical card is the essential gateway to accessing public services in circumstances where equivalent private services simply do not exist.
It is clear that the Bill is a retrograde step. It flagrantly breaks the commitment made in the Fianna Fáil, Green Party and Progressive Democrats programme for Government to extend availability of the medical card. The programme for Government promises to "index the income thresholds for medical cards to increases in the average industrial wage" and "double the income limit eligibility of parents of children under 6 years of age, and treble them for parents of children under 18 years of age with an intellectual disability". This is the least the Government should do. Poorer people suffer more illness and die younger. Many never reach the age of 70 years to qualify for a medical card in the first place. The all-island report of the Institute of Public Health, published in August, pointed out that health inequality was rife in the State. It shows that in the Twenty-six Counties 38% of those at risk of poverty reported suffering from a chronic illness, compared to 23% of the general population. In such circumstances, the Government is continuing to decrease people's entitlement to the medical card.
The partial climbdown by the Government does not go far enough. Universal medical card entitlement for the over 70s should be fully restored. I commend senior citizens for making their voices heard so loudly and clearly. They rocked the Government and brought about the partial climbdown which, I emphasise, does not restore the right that has been taken away. Sinn Féin approaches this issue from a point of principle — on the basis of health care as a right. We believe access to health services should be based on medical need alone. We want the State to move towards a universal public health system in which all citizens would be entitled to free health care services at the point of delivery. The Bill represents a move in the opposite direction. We want a universal system funded by fair and progressive taxation. We believe working people pay taxes in order that decent public services can be provided for them and their families. They pay taxes to ensure they are provided for in their old age. All children and all those who are unable to work or are out of work should be properly looked after.
Sinn Féin is in favour of a public health system that would employ general practitioners directly on set salaries. We have the ludicrous pretence that set GP fees for patients do not exist. We have the nonsense theory under competition law that people will shop around between GPs to find the cheapest one. We all know that does not happen in the real world. What has happened is that some GPs have shopped around instead. They have concentrated in more affluent communities mainly in the cities and in Dublin in particular, leaving less well off communities with a far lower proportion of GPs per head of population.
Debate adjourned.