Amendment No. 1 is out of order.
Health Bill 2008: Committee Stage.
SECTION 1.
Amendment No. 1 not moved.
Section 1 agreed to.
SECTION 2.
Amendments Nos. 1a and 1b are out of order.
Amendments Nos. 1a and 1b not moved.
Question proposed: "That section 2 stand part of the Bill."
The Labour Party is objecting to all of the sections of the Bill because basically we object to the Bill in its entirety. I had proposed an amendment that the section should not be included in the Bill. I realise that the interpretation section is not the most important one in the Bill. Nevertheless I wish to object formally to the section.
As I said on closing the Second Stage debate, the financial sustainability of the automatic entitlement to a medical card on reaching the age of 70 is not possible. I said that the general medical card numbers are increasing by approximately 3% per annum and for the over 70s the numbers are increasing by approximately 7% per annum. Given that a couple, both of whom are in their late 60s, must be earning less than €298 in order to obtain a medical card, I do not believe it is unreasonable in the case of over 70s to have gross income limits of €700 in the case of a single person and €1,400 in the case of a couple. Therefore, I want to maintain the interpretation section which is fundamental to any legislation to make it clear what the Bill is about.
Obviously the Ceann Comhairle has declared out of order two of my amendments, one of which relates to section 1 and the other one which is related. They have been disallowed because they are in conflict with the principle of the Bill. However, I was simply seeking to retain cards for the people who already have them. I would have thought the principle of the Bill was broader than simply the issue of people who already have cards. It is about taking medical cards from people well into the future also. I do not know whether I am in order to raise that matter now. I presume it was the Ceann Comhairle's office rather than the Minister who decided the amendments were not appropriate. They were seeking to retain a category of people, those who already have a card, as opposed to challenging the entire substance of the Bill.
If the Deputy's question is directed to the Chair, the answer is, of course.
The matter is addressed in a further amendment on section 7, which was ruled in order. Can I have clarity? The document I printed from my computer seems to be different to the one before me. Can I be assured I am using the correct document and am not getting confused? There is enough confusion, God knows.
I do not know who will answer that. I call the Minister.
It is a matter for the House, not for me, to decide which document we are discussing.
I am not trying to——
I know Deputy Reilly is not. I want to make it clear that I have no role in having amendments ruled in order or not. It is a matter purely for the Houses of the Oireachtas.
The Committee Stage amendments were published on 11 December and a further supplementary list was subsequently published.
Question put and declared carried.
SECTION 3.
I move amendment No. 2:
In page 4, subsection (2), lines 3 and 4, to delete "this Part by virtue of section 45(5A)" and substitute the following:
"Part IV of the Act of 1970 by virtue of section 45(5A) of that Act".
This is a technical amendment to clarify that the reference is to Part IV of the 1970 Act. The services under Part IV are in-patient and out-patient services, provision of ambulances etc., general practitioner and medical-surgical services. Medical cards are provided as evidence of full eligibility. Persons with full eligibility hold a medical card and are eligible for a full range of services. As I said earlier in a response on Second Stage, many of the issues raised such as appliances, home supports, home care packages and home helps are provided on the basis of clinical need, not on the basis of whether or not somebody has a medical card. Clearly, they are provided for people under the age of 70 if they are deemed to be clinically in need of it, as well as people over the age of 70.
Amendment agreed to.
Amendments Nos. 3 and 3a are out of order.
Amendments Nos. 3 and 3a not moved.
Question proposed: "That section 3, as amended, stand part of the Bill."
Again, on the basis that we oppose this entire Bill, I oppose section 3. It keeps the cards for people who have them until 2 March 2009. We have no objection to people holding onto their medical cards until 2 March 2009, but we object to having them taken from them after that. On that basis, I oppose section 3.
Why is amendment No. 3a ruled out of order? I do not want to have a row about it but I would like to know the reason.
I am not in a position to tell the Deputy. The decision was made by the Ceann Comhairle's office and all queries should be referred to that office.
That is not a satisfactory way of dealing with the matter. We are entitled to know why an important amendment is out of order.
I am not going to be defensive but the Chair does not have a role in that regard. The Deputy will have to find another way. I encourage him to proceed with his contribution.
I appreciate the Acting Chairman has no role in this but we are all big boys and girls here. While the Ceann Comhairle is entitled to rule matters out of order, if a considered amendment on a Bill as important as this is ruled out of order, we are entitled to know the reason. That is not an unreasonable request. I do not want to delay matters but in my experience it is customary to explain that an amendment is out of order because it may impose a financial liability on the State or otherwise. I do not understand why this amendment was ruled out of order.
Section 3 deals with the eligibility issue. It provides that, "Notwithstanding any other enactment, with effect from 2 March 2009 a person also shall have full eligibility for the services under this Part if the person attained the age of 70 years before 1 January 2009 and is ordinarily resident in the State, so long as the person's gross income does not exceed" the gross income specified in the Bill. It is futile to invite the Minister to change her view and stick to the original promise made to people that upon attaining 70 years they would have the full medical card.
My concern about this measure, linked into other measures, is the impact it will have on a number of cases. We will have the opportunity to consider a particular case later when the Minister moves an amendment to section 4 and I want to signpost it. I refer to the manner in which the legislation affects widows and widowers and the peculiarity contained in the legislation regarding who is a couple as defined in the legislation. This interacts with other parts of the legislation.
A series of anomalies arise under this legislation. A married couple qualifies as eligible for the medical card where one is over 70 and their gross income does not exceed €1,400 per week, as specified in the Bill. This Bill, as originally published would have had the effect that if, following the death of a spouse, the surviving widow or widower had an income of €1 in excess of €700 per week, immediately on the death of a spouse the surviving spouse would have had to communicate with the HSE the fact that he or she ceases to be eligible to retain the medical card.
I appreciate we will come to an amendment the Minister has tabled that will temporarily deal with this. However I find it extraordinary that any Government, having given it two months deliberation, could produce legislation that sought to target the bereaved and instantly deprive a widow or widower of an entitlement to a medical card before his or her even having the opportunity to grieve over and lay to rest his or her deceased spouse.
In the context of how this legislation works there is a series of problems. We will come to an amendment the Minister has tabled that provides if one is bereaved and over 70 one can retain the medical card for three years if one originally qualified for it under the terms of the legislation. The problem with these eligibility rules and the definition of a couple is that the definition of a couple applies not just to a married couple but to couples living together outside marriage. This is relevant to this and later sections.
I do not suggest we discriminate against people who live together outside marriage, but the Constitution does not allow us to discriminate against married individuals. We are not allowed, constitutionally, to discriminate against people because they have been married and their spouses have died. What the legislation does in this context is quite odd. It is cruel, it is unconstitutional and, in my view, it is unacceptable. It seems to create a situation — the Minister can correct me if I am wrong — in which a widower or widow can be deprived of his or her medical card but someone who has been living with his or her partner is not.
Let us take as an example a married person who has qualified for a medical card on the basis that he and his wife have a gross income of €1,400 per week or less. If his spouse dies — we will assume it is the husband who survives — and the widower's gross income is €800 per week, he will be deprived of his medical card, immediately under the initial proposal, but under the current drafting, three years after the death of his spouse. However, if a couple are living together outside marriage and thus are not recognised as having any constitutional status as a family, and their gross income is less than €1,400 per week, they will both get medical cards. Under this legislation, a single unmarried individual over 70 with an income greater than that received by a widower will retain a medical card if he or she is living with someone else, while the widower will be deprived of his medical card because his wife has died. I believe this is unconstitutional, because the widower is losing his medical card as a consequence of the State's failing to recognise that despite the death of his spouse he has retained his status as a member of a marital family.
Whereas the State is perfectly entitled to treat couples living together outside marriage in a way that is identical to couples living together within marriage or a married person similarly to the way in which it treats a single individual, it is not entitled to give preferential treatment to persons living together outside marriage as compared to a married person who has suffered a bereavement and who constitutes a constitutional family. I know this is a very complicated argument and I do not want to pretend it is simple, but it is the reality. We have certain constitutional duties. Any Government that would deprive a widow or widower of a medical card because his or her spouse has died does not deserve to be called a Government. It is an inhumane approach that would not be supported by anyone outside this House. Any Government that says to a widower that it will let him keep his medical card for three years and then when he is 74 or 75 it will take it back unless he cohabits — or lives in sin, as some people would view it — with someone else is a Government living on a different planet.
The odd thing about this Bill is that a widow or widower who has been entitled to a medical card under the gross income rules will be allowed to keep his or her medical card provided he or she finds someone else to live with as if they were husband and wife within three years of the death of his or her spouse. Not only is that unfair and inhumane, it is completely bizarre. Under the legislation and the definition as it interacts with this section, the State will apparently allow a couple to keep their medical cards if they are living together as if husband and wife and they are over 70. How is the State to establish whether elderly people are living together as husband and wife? Are we to have a special unit of the Garda Síochána sent to the homes of the elderly to check out their sleeping arrangements if a man and woman are living together in one home? Will the State have to make inquiries as to the level of intimacy of their relationship? If a widow or widower who suffers from ill-health has a companion of the opposite sex who comes to live in his or her home to help with daily needs such as keeping the house clean and cooking the food, at what point are those two people regarded as living together as if husband and wife? What inquiry will the State make of both of them? Why should any person over 70 be put through the embarrassment of such inquiry? Is this Government deliberately setting out to embarrass and cause distress to elderly people?
If an elderly widower was bereaved two and a half years ago and his sister moves in to reside with him, they will form part of a constitutional family. They are obviously sleeping in different bedrooms but they have companionship. Why should the State not consider their gross income to allow both of them to retain their medical cards? If one of them has an income of €800 gross per week and the other has an income of €400 per week, under this legislation they would apparently be allowed to have medical cards if they were intimate together but not if they were not. It takes an extraordinary political mind to produce a Bill that creates such unacceptable and bizarre dilemmas.
The other difficulty the Minister has with all of this — we will go through it again as we move through the afternoon — is that there is a taint of unconstitutionality about this legislation. It discriminates against the family based on marriage where an elderly person is bereaved by the death of his or her spouse. It discriminates against the family based on marriage where a sister and brother are living together in one home, as they are regarded as being part of one constitutional family. Article 41 of the Constitution imposes an obligation on us in this House to guard with special care the family based on marriage. I believe this legislation should be referred by the President under Article 26 of the Constitution for these issues to be examined. I am not going to pretend that anybody with any legal expertise or knowledge of our Constitution could predict with certainty the outcome of any such reference. I am simply raising the issue that there are serious constitutional questions that need to be addressed. I do not think it is appropriate or fair that any person over 70 who wants to defend his or her right to obtain or retain his or her medical card should be put through the stress and possible expense of having to take a constitutional action.
The entirety of this legislation is ill-conceived. This legislation was published last week — I cannot recall whether it was last Thursday or Friday morning. I saw it on Friday. It was produced as last-minute, emergency legislation after the Government had made five U-turns. The sixth U-turn is an attempt to amend in a very ill-considered way the position of widows and widowers. To what extent has this legislation been constitutionally proofed with the necessary consideration by the Office of the Attorney General? To what extent has this issue been addressed in the context of the manner in which it could affect families based on marriage? These are important questions and I hope the Minister will be able to respond to them.
I thank the Ceann Comhairle for the opportunity to speak on section 3 and amendment No. 3.
We are dealing with section 3 because the amendments referred to are out of order. I will therefore take the Deputy's contribution on the section.
So we are dealing with section 3 of the legislation.
Yes.
I wish to make a contribution after Deputy McGrath as I have just received a letter from the Ceann Comhairle——
Please allow Deputy McGrath to make his contribution first.
It is very difficult these days for an Independent Deputy to get speaking time.
I welcome the opportunity to speak on the Bill and on section 3 in particular. This is a sad day for Ireland and a particularly sad day for our senior citizens. I will be voting against the legislation. It was not an easy decision but this is one of the issues on which I had a falling out with the Government and why I withdrew my support for the Government. It is one of three issues that are very important to me, the other two being class sizes and the cervical cancer vaccine. I wish to put this on the record of the House. It was a difficult decision and at times it has led to my being isolated and marginalised within the Dáil, particularly with regard to speaking time, Private Members' time and membership of committees. However, as far as I am concerned, it was the right thing to do because we all have a duty to stand up for our senior citizens and for those aged over 70 years, regardless of their income. It is also an opportunity for us to stand up for those who believe strongly in a universal health care system. I was first elected to the Dáil in 2002 and for the past six years I have been saying that we have to address the issue of providing adequate funding for the health services, particularly for services for the elderly. Such funding should be provided through taxation. The State has a major problem in this regard and we are going in the wrong direction. The senior citizens and the over 70s have drawn a line in the sand as regards the direction this country is taking with the health services. I commend all the senior citizens who were involved in the protest and all those who contacted our offices. They had a significant impact in further developing the debate on issues such as those dealt with in section 3. I refer to the explanatory memorandum of the Bill:
Section 3 provides for the replacement of section 45(5A) of the Health Act 1970 which provided for automatic entitlement to a medical card for all persons aged 70 years and over who are ordinarily resident in the State, irrespective of their means. Section 3 provides that those people who are 70 or over on 31st December, 2008 and who hold a medical card on age grounds will keep their card, so long as their income from all sources does not exceed specified limits. Those whose income is above the specified limits will have until 2nd March, 2009 to advise the HSE that they no longer qualify. They will keep their full eligibility until then.
I welcome this period of space for the senior citizens; it is important to allow time to debate these issues and examine the broader complications and implications of this legislation. I remind the House that I will be voting against the Bill. The vote is an opportunity for all Deputies to indicate exactly where they stand regarding the health services.
I acknowledge that the Minister for Health and Children has done some excellent work in the delivery of services and that she has been very supportive of me in the past two years, particularly with regard to cystic fibrosis. I thank her for the €2.5 million extra funding going into Beaumont Hospital and also for the development of the national centre in St. Vincent's Hospital. If people do good things I will always recognise and value that. I know that many people in this House, including people on the Government benches are very uncomfortable about this decision. For the sake of the small number of people aged over 70, it would be worth doing something right. They also woke up this morning to discover that all of a sudden the Government was able to find €180 million to fund the pig farming industry. I have no problems with that funding because we have an economic crisis and we must provide assistance but I question why the money cannot be found to deal with class sizes, to pay for the cervical cancer vaccination programme or for issues such as medical cards for the over 70s. These are the issues which must be faced. I encourage the Minister to look at the broader issues and not to have a closed mind. I say to the Government that I will be supportive of people who try to resolve the economic crisis but there are certain issues which should never be touched. If the Government is talking about patriotism, it should never hammer the sick, the elderly and the disabled.
I thank Deputy McGrath for that broad-ranging statement.
I wish to raise a point of order.
I will not know if it is a point of order until I hear it.
I came into this House this afternoon for Committee Stage of the Bill which in my view is very rushed. This is very important legislation which will change the social fabric of our country. It proposes to change the principle of universal entitlement to a medical card for those aged over 70 years. The Minister referred to an article in which I was quoted. She said I have not corrected the record of the House with regard to this matter but I say that I have. I did so the last time this motion was before the House. I said then that this was brought in as a political stroke but it had transpired to be a major measure bringing marked social and public health gain to this group of people. I also said I am humble enough to put my hand up when I am wrong. I would further say that as somebody involved in evidence-based medicine, when new evidence comes to light, it is the practice to take it into consideration in context and change one's actions if that is what the new information demands.
The Minister has made some terrible decisions and done some dreadful damage to our health service but thank God she is not the Minister for Justice, Equality and Law Reform, because if she were, people would languish in jail long after it had been proven they were innocent of the crime for which a jury had found them guilty.
What really has incensed me today is the manner in which proceedings on this Stage are being conducted. We have submitted numerous amendments to the Bill. I was only in the Chamber for ten minutes when I received a letter from the Office of the Ceann Comhairle to inform me that my amendments Nos. 1a, 1b, 6a and 6b, have been ruled out of order on the grounds of being declaratory in nature and that amendments Nos. 3a, 3b, 3, 3d, 3e, 5b, 5c, 5d, 5e, 5f, 5g, 5h, 5i, 5j, 5k, and 5l, have been ruled out of order on grounds of being a potential charge to the Revenue. How many of the amendments submitted by Deputy Jan O’Sullivan and I are not out of order? This is nonsense about amendments being declaratory in nature. I cannot see how they are out of order in this regard. They do not run contrary to the Title of the Bill. They are aimed at people coming in after 1 January who will be over 70. I want to register my objections in the most strenuous possible fashion. I find this totally unacceptable. This is muzzling democracy, muzzling the Opposition to prevent us putting forward the case for people in this country who showed their anger outside the gates of this Dáil, when 15,000 people turned up in wheelchairs, zimmer frames and any other mode of conveyance they could get, to register their upset, abhorrence and annoyance at the unacceptability of this legislation.
As we pointed out in the past, for the measly sum of €16 million that was saved, is this then about depriving the elderly of their medicine? It seems we are not to be allowed table and discuss amendments which would allow some of the provisions in this Bill to at least be ameliorated. In my view the Government is going to persist with a Bill which will have a retrograde effect on our society and on what we stand for.
The Minister has spoken in the past about social solidarity across the generations for insured people but now she wants to take the medical card away from people in their 70s and at the end of their years. I utterly reject her contention that we cannot afford universal entitlement. I contend we should have it for all age groups. We will come to this House with the means of doing this in a way that the country will be able to afford and when the current wastage in the HSE, of which we all have heard so much, is dealt with. I find it objectionable that these amendments will not be discussed. As Deputy Shatter said, we will not be in a position to ask why a person who loses his or her spouse will also lose the medical card. Why can they not be left with their card? I must take advice on this matter but I am so exercised by this. What amendments are left to discuss? Will the Chair inform us?
The Deputy has made his point. Unfortunately, the Chair has no role in the question he asked with regard to the Ceann Comhairle's office. I have allowed the Deputy make his point and I made no attempt to muzzle him.
With respect to your good self, Acting Chairman, perhaps the Ceann Comhairle should be asked to attend the Chamber. In all the years I have been a Member — I have been a Chief Whip and an Opposition Whip — I have never seen amendments ruled out of order on the basis that they were declaratory. That is a ridiculous argument to put to anybody. This is a debating Chamber. We are here to debate issues. If the Government does not like what we are saying, we can push it to a vote. That is why we have a voting system. Debate has to be allowed. Are we going to be muzzled to the point that we can only speak to a stupid point of principle that someone decides on?
This letter from the Ceann Comhairle is not a proper explanation as to why the main Opposition party's amendments should be ruled out of order. We live in a democracy. I appeal to you, Acting Chairman, to ask the Ceann Comhairle to come to the Chamber to answer our queries because you are creating a precedent. Some day you might be over on this side of the House and you might feel what it is like not to be able to debate issues. Once this decision is taken, there is a precedent. Precedents are covered by Standing Orders. I do not want to create a precedent. What does "declaratory" mean? What is wrong with the amendments?
The Chair is advised that I am not on this occasion creating a precedent.
No, it is not you, Sir.
I take the Deputy's point. His remarks will be brought to the attention of the Ceann Comhairle's office.
It will be too late then because the Bill will be finished.
The Bill will not be finished.
We will have gone past the appropriate amendment.
Once this Stage is passed, we move on to Final Stages. There will be no further opportunity to debate the matter. There will be a vote.
The Chair is in a position where I must abide by the order of the day. The Chair is advised that once amendments are ruled out of order, the Chair does not have a role in that regard. I am advised that any inquiries must be addressed to the Ceann Comhairle's office. Perhaps the Deputies might take the opportunity to do that.
I have just completed two days of Committee Stage of the Finance (No. 2) Bill which had amendments with the same principles contained in some of these amendments being ruled out of order. It is difficult at this point to argue about it when we have just received this letter. The Acting Chairman should adjourn for ten minutes to allow the main Opposition party examine this because almost every amendment is ruled out of order.
Only two amendments are left.
We need an adjournment.
On a point of order, as I can only make one contribution on this before the Minister replies, I want to raise the same issue about two of my amendments that were ruled out of order.
We are on Committee Stage, so I will not be restricting the number of times you can come in.
Can I come in again before the Minister replies or is it after?
If you so wish.
I will allow Deputy Barrett finish. If there was going to be a suspension, I wanted to have the opportunity to express my views on my amendments which were ruled out of order.
It is unreasonable when the main Opposition spokesperson is sitting in the Chamber and a letter is presented to him that rules out 12 of his amendments. The explanation given is quite unclear. In my opinion, it will create a precedent. The only way to solve it, and rather than being unruly in the House, is to adjourn for ten minutes to allow us discuss the matter.
The difficulty we are in highlights the exact reason that no Government should ever order Committee Stage to commence half an hour after Second Stage. It is outrageous. Having had nine weeks to progress this Bill, we are being put in this position by the Government. We should not be. This is undermining the role of the House.
I am sure the Minister for Health and Children will tell us, if we ask her, that she has had no role in ruling out these amendments as it comes from the Ceann Comhairle's office. The Minister is subject to quite an amount of criticism. I am not going to criticise her for something she may have no hand or part in. I would be interested, however, to know what advice the Ceann Comhairle's office got from her Department on these amendments. I support what has been said. We should adjourn to allow the Ceann Comhairle to come back to the Chamber to explain the position in respect of specific amendments.
I will allow Deputy O'Sullivan to speak for herself, but Deputy Reilly's amendments Nos. 1a and 1b are not declaratory. They actually impose legal obligations on the Minister if they were enacted. Declaratory is something that declares something to no effect. Amendments Nos. 1a and 1b, if enacted, would impose specific obligations on the Minister.
What has been said about amendment No. 5o is extraordinary. This amendment, in my and Deputy Reilly's name, seeks to ensure any person who has a medical card will not lose it as a consequence of being rendered a widow or widower. My earlier amendments would address the scenario of where a person over 70, who through bereavement becomes a widow or widower and as a consequence has €1 in excess of the €700 threshold, will not be deprived of a medical card. This is a very straightforward principle. The Minister has tabled a similar amendment which would allow such cases to retain their medical card for three years, a proposal I criticised earlier.
The Minister and this side of the House are addressing the same issue — the Minister, from my perspective, in a minimalist way and Fine Gael from a humanitarian and correct way. However, we are both still addressing the same issue. We are told, however, that these amendments are ruled out of order because they conflict with the principle of the Bill. Is the Minister's amendment in conflict with the principle of the Bill? If our amendment is ruled out for that reason, her amendment must be ruled out too, in which case the Bill should be withdrawn. The Bill will have an impact on widows and widowers that even the Government is resiling from.
The main principle of the Bill appears to be not simply to target everyone currently over 70 who has a medical card, but to target the rest of the community who might attain the age of 70 in years to come. If we were to undermine the principle of the Bill — I would understand this being ruled out of order — it would be through an amendment that simply stated the absolute right to a medical card that people over 70 have should continue, and continue in future years for everyone who attains the age of 70. It is Fine Gael's view that people should retain the medical card on reaching the age of 70, but we know we cannot table an amendment that would effectively nullify the impact of the Bill. Amendment No. 5o does not nullify the Bill. It is not contrary to the principle of the Bill. It is simply providing a different type of an amendment to the one tabled by the Minister to protect the position of widows and widowers.
I do not accept it is out of order, nor can I accept that Deputy Reilly's earlier amendments are out of order. We should get an explanation from the Ceann Comhairle. If these issues cannot be dealt with properly today, this House should adjourn, move on to other business, and we should come back to this Bill next Tuesday. The House should not be muzzled in dealing with an important item of legislation that will impact on the health and well-being of thousands of people over 70 in this country.
There are a number of matters to which I want to respond in respect of issues raised by Deputy Shatter. I will then turn to technical issues.
The Bill was drafted by my Department in consultation with the Office of the Attorney General and was personally overseen by the Attorney General. In the intervening period between the remarks made by Deputy Shatter yesterday and today, the Attorney General is totally satisfied that the points made are not valid. If they were valid, it would mean that social welfare entitlements that changed on someone being widowed or tax law and other areas could equally be invalid. The reason we are writing in the provision is to put it beyond any doubt that someone's card will not be whipped away, as Deputy Shatter puts it, on the death of a spouse. That is the practice in respect of over 70s and under 70s. As a matter of practice, the card is left with people until it comes up for renewal. It is not the case that the day one becomes a widow or widower, the HSE takes away the card regardless of the age of the people involved.
My office has no role in respect of technical issues. The Department does not give advice to the Ceann Comhairle, his office or the Bills Office. The Ceann Comhairle makes these decisions on the basis of the independent officers in this House who have served us well over many years. It would be helpful if the House were to adjourn for some time to allow the parties opposite to discuss the matter with the Ceann Comhairle and his officials so that we can spend the time available discussing the issues contained in the Bill. It is a matter for the Acting Chairman.
My understanding and the advice is that if I have a proposal from the floor, I can order an adjournment for a specified time.
I so propose.
For how long?
Some 15 minutes.
I presume we will not complete dealing with section 3 until after the adjournment.
The Chair is advised that if an adjournment is agreed now, it will be for 15 minutes and we will return.
Will we return to that section?
Yes.
In that case I will not address the issues in the section at this stage.
Regarding the issues we are adjourning for, I support what Deputy Barrett says. I am not a Member for as long as he is but I have never heard of an amendment being ruled out of order because it is declaratory. The letter I got from the Ceann Comhairle states that my amendments are ruled out of order because they are in conflict with the principle of the Bill. In the explanatory memorandum to the Bill, I cannot find any determination of the principle of the Bill. It is not clarified. The explanatory memorandum refers to the purpose of the Bill, which is to introduce a new scheme for entitlement to medical cards for persons 70 and over with effect from 1 January. I cannot see why my amendments offend that principle.
In these amendments I am trying to retain within the Bill those who already have the medical card. I contend that my amendments should not have been ruled out of order. The substance of the principle of the Bill is to make permanent provision for a means for people over 70. My amendment deals with a specific group of people, those who already have a medical card. If the Ceann Comhairle is listening to this debate before making a decision, I ask that this be taken into account.
Is the proposal that the House be suspended for 15 minutes agreed? Agreed.
Sitting suspended at 3.05 p.m and resumed at 3.30 p.m.
I understand Deputy Jan O'Sullivan was offering when the House adjourned.
Technically, we are addressing section 3 because the Ceann Comhairle's office has decided that the various amendments proposed to section 3 are out of order. I do not concur with the decision that amendments Nos. 1 and 3 in my name are out of order. The reason they were ruled out of order was that they were in conflict with the principle of the Bill. Nowhere specifically states what is the principle of the Bill. The only places I can find any possible statement of the principle of the Bill are the explanatory memorandum and the Long Title.
The explanatory memorandum states, "The purpose of the Bill is to introduce a new scheme for entitlement to medical cards for persons aged 70 years and over, with effect from 1st January, 2009." The Long Title of the Bill states it is:
AN ACT TO AMEND THE HEALTH ACT 1970, THE HEALTH CONTRIBUTIONS ACT 1979, THE SOCIAL WELFARE CONSOLIDATION ACT 2005 AND THE CIVIL REGISTRATION ACT 2004, TO MAKE PROVISION IN RELATION TO ELIGIBILITY FOR SERVICES UNDER THE HEALTH ACT 1970 AND FOR LIABILITY FOR HEALTH CONTRIBUTIONS AND TO PROVIDE FOR MATTERS CONNECTED THEREWITH.
Neither of these areas, and they are the only places I can see any statement of the principles of the Bill, indicates that the purpose of the Bill is to take away eligibility to medical cards for all those aged over 70 unless they satisfy certain means tests.
My two amendments relate specifically to the retention of the medical card by those already in possession of it. In other words, while the Labour Party fundamentally objects to the entire Bill, these two amendments relate only to a category of persons, namely, those already in receipt of a medical card on the basis of being over 70 years of age. These amendments do not seek to address the entire substance of the Bill but merely to amend it in order to exempt a specific category of persons.
Therefore, I contend that the amendments should not have been ruled out of order. I am very concerned that a precedent may be established whereby Opposition Deputies will, in future, be ruled out of order when they table amendments similar to these in order to protect certain categories of people from the effects of the legislation in question.
In the letter I received in regard to the amendments tabled in my name and that of my colleague, Deputy Reilly, with particular reference to amendment No. 5o, I am told they must be ruled out of order because they are in conflict with the principle of the Bill. This is directly relevant to section 3, which includes a provision whereby a person who had full eligibility for medical card services prior to the coming into operation of the Bill will continue to have full eligibility until 2 March 2009. Amendment No. 5o, which has been ruled out of order, provides that: "A person who had full eligibility for a medical card having attained the age of 70 years prior to 1st January 2009 shall not lose their medical card as a consequence of any provision contained in this Act."
This amendment has the same intent as that of Deputy O'Sullivan's amendment No. 3, which is to ensure that when this Bill comes into force, anybody who is over 70 on 1 January 2009 will not be deprived of a medical card. Like the Labour Party, we also disagree with the overall approach of this Bill, and we voted against it on Second Stage. Fianna Fáil, Green Party and Independent Members who support the Government voted in favour of it. This particular amendment does not conflict with the principle of the Bill, because that principle is to delimit the entitlement of over 70s to medical cards from 1 January and for the future. That will continue to happen even if these amendments are accepted.
A Cheann Comhairle, this is an extraordinarily dangerous precedent. The Bill, in its Long Title, does not detail a principle, namely, that the Government is revoking the universality of medical card provision. That is not stated. As set out by Deputy Jan O'Sullivan, the defined purpose of the Bill is effectively to amend existing legislation. With the greatest respect, it is not the function of the Office of the Ceann Comhairle to glean principles from Bills that are unarticulated in the Bills as published and, thereby, to constrain Opposition parties from seeking to improve upon and amend legislation in the public interest.
Moreover, it is somewhat ironic that it should be suggested that what we are doing is in conflict with the principle of the Bill. This is particularly unprincipled legislation. It contains no discernible, laudable or identifiable principle. It is very dangerous, in a parliamentary democracy, to curtail the capacity of Opposition parties to propose amendments to Bills to delimit their detrimental impact. I contend that a principle has been gleaned that is unsustainable and not articulated in the Bill. I ask that this be reconsidered.
This Bill can be enacted while preserving the rights of those who, as at 1 January 2009, are eligible for medical cards under the law as it is today. That will not impact the Bill's main effect, of which some of us do not approve. If it were our objective in these amendments to undermine the principle of the Bill, their acceptance would render the Bill nugatory and nullify in total its impact if enacted. I accept that we cannot do that, and that is not the intention of these amendments. I ask the Ceann Comhairle to reconsider his ruling. There are many elderly people looking to us to ensure that the rights they currently enjoy are preserved. They have a legitimate expectation that not only the Government but this House will protect their rights.
I acknowledge that the Bills Office is under pressure. We did not allow circulation of our amendments until the required time as a protest against the guillotine being imposed on this Bill. I remind both the Ceann Comhairle and the Minister that rushed legislation invariably comes back to bite us. There are issues in this legislation that may well come back to bite us, notwithstanding the advice from the Attorney General. There have been several instances where rushed legislation, including the Bill dealing with the Medical Council, required further amendments shortly after enactment. I envisage similar problems with this Bill.
I must take issue with the Ceann Comhairle's ruling. Deputy Jan O'Sullivan has read out the Long Title and the explanatory memorandum. Nowhere is the principle of universality mentioned. We are in dangerous water when the Office of the Ceann Comhairle can find a principle within a Bill and obstruct Opposition amendments by ruling them out of order on the basis of that principle. Let the amendments stand and let the Government exercise its majority in the House.
I will not repeat the arguments already made. We should be allowed to discuss the merits and demerits of the amendments. There is undoubtedly precedent in law for what we are proposing. I recall that when the Government of the day realised in the 1980s that the construction grant scheme for older homes was proving to be very expensive, it changed the law to cease operations forthwith. However, following legal advice, it was subsequently obliged to allow anybody who had entered into a contract with a builder to continue that work because there was a legitimate expectation of a contract with the Government. People who are over 70 years of age and are currently in receipt of a medical card have a legitimate expectation that they would retain those cards for the remainder of their life, as promised by the Government. These cards were not granted subject to financial circumstances or the onset of a recession. They were given for life.
I cannot accept the determination of the Ceann Comhairle's office that these particular amendments are out of order. I accept that some of the other amendments, referring to gross and net incomes, could be construed as having a potential cost to the Exchequer, but that is not so in the case of amendments Nos. 5o and 3a. Like my fellow Deputies, I object strenuously to this decision, which creates a dangerous precedent and undermines the role of this House and of democracy. Nobody on this side of the House can see a legitimate reason for this decision. I am sure the Minister has no problem discussing the amendments if they are found to be in order. It falls to the Ceann Comhairle to reconsider this decision.
I accept that the Ceann Comhairle has a job to do and I do not mean to show any disrespect to his office. However, in this instance, I say with respect that I do not believe he is entitled in any way to rule out these amendments. It is not his function to deal with the legislation as presented by the Government. The Long Title of the Bill sets out its purpose of making provision in regard to eligibility for services under the Health Act 1970 and for liability for health contributions and so on. Nowhere is there mention of any principle. The purpose of the Bill is set out in more detail in the explanatory memorandum, and this is the key issue. Its purpose is to introduce a new scheme for entitlement to the medical card for persons aged 70 and over with effect from 1 January 2009.
However, that is subject to the Bill being passed by the House. One cannot anticipate what will happen to this legislation until the Bill is passed. The purpose of the Bill, therefore, is the issue at stake here. That purpose, as stated by the Government, is to introduce a new scheme for entitlement to medical cards for persons aged over 70.
With the greatest respect, a Cheann Comhairle, you and your advisers are not entitled to prevent this House from debating the Government's proposals regarding the introduction of the new scheme. You are going to enter into the book of precedents another rule that is totally out of order. You constantly remind us, and rightly so because of your office, that if we wish to change the rules, there is a means of doing that. In this instance, however, we cannot go to the Committee on Procedure and Privileges and change a rule because this is a Bill introduced by the Government.
The Government has clearly outlined its wishes. We might disagree with its wishes but that is what divisions are for. When the vote is taken and the Bill is passed, if it is passed, that is the end of the matter. However, in the meantime an Opposition party is entitled to table amendments which might be contrary to the wishes of the Government. That is what debate is about. If we can persuade enough people in this Chamber to agree to our point of view, the Government will have to change the Bill. The Chair is not giving us the opportunity to persuade other Members in the Chamber to adhere to our point of view.
In all my years as a Member of the House, I have never encountered a situation like this. I can understand an amendment being ruled out of order on the basis that it imposes a charge but ruling it out of order because it is contrary to the principle of the Bill is another matter. Where is the principle? Will the Chair kindly point out where the principle of this Bill is set down, either in the legislation or in the explanatory memorandum? In your letter you said an amendment is contrary to the principle, but we cannot find the principle.
The amendments submitted by Deputy Reilly have not been circulated to me. They were not left in my post box. The only list of amendments I received was the list circulated earlier by Deputy Jan O'Sullivan. That is contrary to the rules of the House because Members are entitled to see all the amendments. They have not been circulated. I am depending on a loan of the list of amendments submitted by Deputy Reilly to make my case. Where is the list of amendments? It has not been circulated even though we have started Committee Stage. That is contrary to the rules of the House.
I thank Deputy Reilly, Deputy Shatter and Deputy Jan O'Sullivan, who were reflecting the views of Deputy Barrett and other Members of the Opposition, for calling to my office to discuss this situation. The difficulty is that amendments Nos. 1a, 1b, 6a and 6b in the name of Deputy James Reilly have been ruled out of order on the basis that they are declaratory in nature. The amendments seek that the Minister shall make various reports to the Dáil.
Amendments Nos. 3a, 3b, 3c, 3d, 3e, 5b, 5c, 5d, 5e, 5f, 5g, 5h, 5i, 5j, 5k and 5l, also in the name of Deputy James Reilly, were ruled out of order on the grounds that they involve a potential charge on the Exchequer. They all seek to increase the range of eligibility for medical cards and for that reason they have been disallowed. Only the Government or the Minister representing the Government may bring forward a proposal which involves a charge on the Exchequer.
Amendment No. 5o, in the name of Deputy James Reilly, has been ruled out of order on the grounds of it being in conflict with the principle of the Bill. I will deal with that in a moment in the context of Deputy Jan O'Sullivan's amendments, Nos. 1 and 3, which have been ruled out of order on the same grounds. To deal with that which appears to be the kernel of the issue today, the principle of the Bill is the general principle which is deemed to have been passed after the Second Reading has been voted on in the Dáil. In this instance the Bill was read a Second Time and passed. It is set out in Standing Order 127 that, on Committee Stage, amendments must be relevant to the provisions of the Bill and must not be in conflict with the principle of the Bill as read a Second Time.
It is true, as Deputy Barrett says, that an individual might have a different interpretation of what is the principle of a Bill. The principle of the Bill in this instance is considered to be that the principle of universal availability of medical cards to persons aged 70 years and over will end. Due to the fact that the amendments put down by Deputy Reilly and Deputy O'Sullivan are in direct conflict with that principle, amendments Nos. 1, 3 and 50 have been ruled out of order. No new precedent is being created today. These are precedents of long standing and I am not changing the rules of the House in any way. I understand that Members might feel that the general principle of the Bill is different from what I have outlined, although I find it hard to see how one could disagree that it is, in fact, the general principle of the Bill as passed on Second Stage.
My new difficulty is that rulings made by the Chair cannot be challenged on the floor of the House without the House descending into grave disorder and being unable to discuss business further. While I understand and appreciate that Members might have a different view, my rulings have been made in a dispassionate, neutral and objective manner. I ask the Members on that basis to proceed with consideration of the legislation. Committee Stage is due to terminate later this evening and Members will wish to discuss the other amendments that have been deemed to be in order.
A Cheann Comhairle, you are held in high esteem in this House. I hold you in high esteem too. I mean no disrespect but the dangerous territory you have arrived at is where one man's meat is another man's poison. You used three words to describe your actions. I am not sure if you used the word "fair", although that would be your view, but you used the words "dispassionate" and "objective". That is the difficulty. Your objectivity in this regard is difficult for us to understand when neither the Bill's Long Title nor the explanatory memorandum mention the principle. If we have now established a precedent in the House whereby neither Government nor the Opposition can argue with a third party's — be it you, your office or the Bills Office — interpretation and perception of a principle that is not clearly stated, we are in dangerous water. It is not a good day for democracy. I say that with the height of respect and the best will in the world to you. It is a dangerous place to go.
I have not been a Member of the House for long but I have listened to others who have been Members for a long time. They are flabbergasted at this. It is not logical that matters that are so important to the State can be ruled on in this fashion. We are talking about changing the law on eligibility for medical cards. We have sought, in amendment No. 3, to ameliorate this proposed change. The amendment is not in conflict with the principle. We do not agree with the loss of universality and seek to ameliorate the hurt and harm done to people who have, as I stated, legitimate expectation.
To return to the first point I made, if a third party rules on this matter because it is his or her perception that a principle, which is not clearly stated, is X, Y or Z, we will be in trouble and this day will come back to haunt the House.
The difficulty legislators face is that different words are used in the Bill — either in the Long Title or explanatory memorandum — and in the rulings made from the Chair. The Ceann Comhairle refers to the principle of the Bill. While the text states the purpose and Title of the legislation, it does not state a principle. As a result, we are now in a position in which the interpretation as to what is the principle of the Bill is left to the Office of the Ceann Comhairle. I do not mean this personally.
While I accept that Deputies are not in a position to challenge a decision of the Ceann Comhairle, if this ruling remains on the record and becomes a precedent, it will be necessary to require Ministers to write a principle into all legislation they propose to present to the House. Members will then know what is the principle of a Bill and will be able to ascertain when amendments are in conflict with it. If this is not done, Members will not know what is the principle and will, therefore, try to interpret what it is.
As a result of this ruling, it will be necessary to ensure the language of the rulings of the Office of the Ceann Comhairle and the manner in which Bills are presented coincide. I will not be satisfied unless this occurs as otherwise a dangerous precedent will be set in terms of the right of elected representatives to propose amendments to legislation. As Deputies indicated, the Government is entitled to vote us down but the interests of parliamentary democracy require that Deputies be entitled to propose reasonable amendments to legislation. This ruling will seriously curtail that right unless the language used in legislation and rulings from the Chair coincides. If Deputies are to be in a position to amend legislation, they must clearly understand what are the principles of a Bill.
I have just spent two days dealing with Committee Stage of the Finance Bill in the Select Committee on Finance and the Public Service, during which a number of amendments were tabled requesting the Minister for Finance to make reports by specified dates. These amendments were not ruled out of order but debated. It appears, therefore, that different rules apply when legislation is debated in the Chamber.
The purpose of the division on Second Stage was, to use the words in the Bill, to allow the Government, in principle, "to make provision in relation to eligibility for services under the Health Act 1970 and for liability for health contributions and to provide for matters connected therewith". The House divided on this issue and a decision was taken by majority vote. The division was not on a principle but to allow the Bill to proceed.
With the greatest respect to whoever interprets the Title as a principle, the Title clearly states what is the purpose of the Bill. It is "an Act to amend the Health Act.... to make provision in relation to eligibility for services under the Health Act 1970 and for liability for health contributions and to provide for matters connected therewith". That is the issue on which the House divided. I fail to understand how an amendment which differs from something in the Bill is contrary to the principle in the text, that is, to make provisions and so forth. Until such time as the legislation is voted through, this will remain the principle of the Bill.
With the greatest respect, consistency is required in the approach taken to legislation in committee rooms and the Chamber.
I have no wish and I am sure Members do not wish to engage in a long debate on this issue. President Jefferson once disagreed with a judgment of the great American jurist, John Marshall. In trying to explain the difference between the Executive and Judiciary, the president stated, "John Marshall has given his judgment; now let him now enforce it". In the same way, while Deputies may or may not agree with a judgment, we have to acknowledge that somebody must make it. I am the Ceann Comhairle entrusted with having to make this judgment and I am not only entitled to make it but obliged to do so.
Deputy Barrett and others referred to the Long Title to the Bill. It will be clear to Members that the Long Title to legislation in this House is voted upon and agreed on after the end of Committee Stage and after other sections have been dealt with. The reason is that the Long Title reflects the contents of the legislation, not the other way around.
Where is the principle?
The principle is established on Second Stage.
No, it is not.
The principle of Second Stage of this Bill, as passed, one which has been accepted by my office, is that the legislation amends the position whereby there was universal availability of medical cards for those aged 70 years and over. The reason the amendments are being disallowed is that they essentially seek to restore the status quo and the principle, if one likes, of universality. That is the difficulty I have and in those circumstances I ask Members to accept the ruling of the Chair. While I fully understand that they may disagree with my ruling, as they are democratically entitled to do, unfortunately somebody has to make the ruling.
The amendment does not seek to undermine the totality of the Bill but seeks to ensure that those who currently hold a medical card are allowed to retain it. The Minister has made a decision regarding those who come later and the Government will agree with her. I suggest that rather than spending the time remaining discussing the Ceann Comhairle's ruling, to which we strenuously object, the House refer it to the Committee on Procedure and Privileges for further discussion.
I am bound by the order of the Dáil of this day to proceed with the legislation.
This issue, which we regard as a precedent——
It is not a precedent. I am obliged in accordance with an order of the——
I suggest the Committee on Procedure and Privileges discuss the ruling as opposed to the Bill.
I have no difficulty with the issue being discussed at a meeting of the Committee on Procedure and Privileges or by way of substantive motion. If Members feel aggrieved by a given decision, there is provision to table a substantive motion. I remind the House, however, that the Committee on Procedure and Privileges has never constituted an appellate body.
To be constructive and enable business to proceed while taking account of the point made by Deputies Reilly and O'Sullivan, the issue is that Bills are published with Long Titles that are supposed to detail the principle or purpose behind them. Instead of doing this, however, it has become the practice of Government to detail, as has been done here, references to particular Acts so as to obscure for the general public the true intention of proposals published and facilitate Governments engaging in public relations campaigns.
While I understand the Committee on Procedure and Privileges cannot address the problem before us, we should refer to the committee a request that it introduce a new rule to require Governments, when publishing Bills, to expressly detail what is the principle of the Bill in straightforward, simple English terminology, rather than simply reciting the details of existing statutory measures they propose to amend. An important principle is at stake here.
I accept the Ceann Comhairle dealt with this in good faith and I would not impugn in any way the ruling in that context. The Government, in the manner in which it has dealt with this Bill, and the Long Title it has put in it, has put him in an impossible and unfair position whereby he must make decisions of a nature the Government lacks the courage to make. It tries to make the Bill appear to be something it is not.
The intent of the Bill appears to be to deprive a whole section of the community of the right to a medical card, a right currently vested in them. The Government wants to confuse the issue and make it look more complex. The Committee on Procedure and Privileges should expressly require Governments or Oppositions who publish legislation to detail, in the Long Title, in simplistic terms, the intent and principle of the Bills coming before the House. This would ensure the Ceann Comhairle would not be placed in a similar position in future.
The Committee on Procedure and Privileges is not an appellate body and was never intended to be so. There is no difficulty in Deputy Shatter, or any other Member, rasing the matter at the committee through his or her party representative.
What is proposed by Deputy Shatter was what I suggested when I spoke previously. The difficulty is that the language used by the Office of the Ceann Comhairle in saying the principle of the Bill is being offended or that we are in conflict with the principle of the Bill is using a word which does not appear anywhere in the Bill as presented to us. I have no problem with raising the matter in the Committee on Procedure and Privileges if that is the appropriate way to proceed. Otherwise, I suggest the Office of the Ceann Comhairle needs to engage with the Bills Office or the offices of the various Ministers to ensure the same language is used. We need absolute clarity that in future we will not have amendments ruled out of order on the basis of this precedent. Otherwise, Opposition spokespersons will be strictly curtailed in how they can propose amendments. We will also have no sense of clarity on whether or not we are offending the principle of the Bill, because we will not know its principle. We need that clarity. If it can be done through the Committee on Procedure and Privileges, that is fine, but it needs to be done one way or another.
The Ceann Comhairle made a statement, which has gone on the public record, that once a Bill has passed Second Stage certain things are forbidden to happen on Committee Stage. That is a dangerous principle because a wide interpretation can be taken on what one can or cannot put down.
If Second Stage is to establish a very tight principle that will be judged by the Chair, it can rule out many amendments in the future. I dispute the contention that when we voted on Second Stage we accepted a principle in a Bill which does not specify that principle. We voted on Second Stage that the Bill proceed to Committee Stage. We did not vote a principle on Second Stage. For future reference, if someone refers to the Ceann Comhairle's statement on this day at this time, it could have serious consequences for future amendments to other legislation.
All I can do is refer Deputy Barrett to Standing Order 121. It is a long-standing Standing Order of the House that the principle is established on Second Stage. That has been the position long before I arrived in the Chair.
It does not provide for a principle. That is the whole point.
That is where we stand.
The legislation does not provide for it.
We will move on with section 3. Everyone has made their point. Deputy O'Sullivan was in possession in opposing section 3.
I intend to press my opposition to section 3 to a vote because it is the substantial part of the Bill as it is the section which amends the Health Act 1970 by delineating certain categories of people over 70 who will no longer be allowed to have a medical card. It will take the medical card away from over 70s unless they happen to comply with the means test. It not only includes income but also savings limits. When I spoke on Second Stage I referred to people who have savings over the limit because they sold their house to be able to pay nursing home charges. Many people will be excluded from this and it is not true to say they are all millionaires. A number of Members quoted from letters from the Retired Teachers Association, which indicated that the means test would exclude retired teachers. Many other categories of people, who would not be considered to be very rich, will be excluded because of this legislation.
I will push my amendment opposing section 3 of this Bill because it is the fundamental section dealing with the substance of a Bill I consider to be harsh and cruel and takes away the principle of universality established for those over 70.
Regarding section 3 and gross income, I ask the Minister, Deputy Harney, to clarify a matter. It defies logic that the Bill does not recognise the concept of net income when that income arises from rental property. The definition of gross for somebody in that position is not catered for.
The Bill also does not allow for someone to be means tested on an individual basis, if that is what they so wish. This Government has been forward in expressing its desire for individualisation for the purpose of the tax system, but on this matter it goes in the opposite direction and does not allow for individuals to be tested on an individual basis. A spouse with no income cannot seek individual testing. That could result in such a person being deprived of a medical card even though they have no direct income. There is no choice in the matter. I am flabbergasted to see the Government allows for individualisation in a policy area such as taxation but insists on joint incomes in this instance.
I am concerned that the word gross is used constantly. Deputy O'Sullivan mentioned those who sell their property to move into a nursing home. Their income is derived from property. A person's sole income could come from rental property. Allowances should be deducted from rental income to allow a person to qualify for a medical card under the provisions of the Bill. I am interested to hear the response of the Minister, Deputy Harney.
I concur with the other speakers on this matter. In this type of situation it is important to remember the vulnerability of those directly affected. Elderly people are vulnerable for a number of reasons. They are unsure and uncertain about their income, accommodation and health for the future. The chances and possibilities are that their health will not be as good as it had been in the previous 30 or 40 years. Health is a peculiar, mercurial thing, but particularly so for the elderly.
I am amazed at the proposal to retract an undertaken given to the elderly before the 2002 general election. It is repugnant because it brings a cynicism to the debate about political decisions and political promises. It is a swingeing, searing, savage attack on people who have worked their whole lives and given their best to society. They are now being told that the little concession given to them by the Government seven years ago will be taken back because there is a problem. The impact on the people concerned is likely to be much greater than anticipated. The level of administration of this scheme will be counterproductive, as we all know because we deal with this kind of thing every day.
A person may have a long-term illness, and €700 per week would not go very far in such circumstances. In such a situation, the Government is attacking a group of people who have done no wrong. There is no necessity to attack people like that at all, because they have not offended anybody. They have done some good service to the State but, as a doubtful reward, they are now being called upon to make a sacrifice. A Leas-Cheann Chomhairle, how many times have you dealt with people whose resources have been spun out and who are looking to the future with great trepidation? They know well that their income is restricted and if anything goes wrong, they are twice as vulnerable.
I did not have the chance to debate this on Second Stage because the guillotine was used then and we know why. I hope the Minister has thought carefully about this. I can assure her that people who are likely to be affected by it are thinking very carefully. I hope that the impact on them is not as negative as it appears to us on this side of the House.
This section provides for the deadline for the full implementation of what can only be regarded as the fatal Government decision to axe the automatic card entitlement for the over 70s. I described the Minister's amendments as face-saving arrangements. They are wrongly presented as a climb-down. They are face-saving arrangements and it will take until 2 March 2009 to implement them. We may be confronted with further enabling legislation, so the Minister might like to comment on that. The reality is that the right to services is being taken away.
I recall well how Fianna Fáil and the Progressive Democrats danced at the birth at the roll-out of the universal entitlement to medical cards to those over 70. We are now witnessing, in this hollow effort by the Government, Fianna Fáil, the Minister, Deputy Harney, and the Green Party attempting to dance on its grave. We are seeing the end of even partial universal entitlement, something which we regarded as a first step towards its ultimate roll-out for all citizens.
This section is wholly obnoxious, as is this entire Bill. I view the entire exercise as callous and ill considered, and bungled from the outset. I oppose the section, as I will oppose at every opportunity the passage of this Bill. I tabled a single amendment on Second Stage and on which we already voted. I did this because no matter what amelioration may be won in negotiating with this Minister, senior citizens in this State will be excluded from what should be their entitlement to a medical card.
I also oppose this section. This is the meat of the Bill, and it will remove the entitlement of people over 70 to a medical card. They have grown used to that medical card, and some of them have had it for seven years. Now they are facing its loss. As Deputy Barrett pointed out, the fact that the income threshold has been changed from net to gross income will cause difficulty for many people. I got a telephone call today from someone who gave 30 years' service to the public sector and who worked in this very building. She will now lose her medical card.
These people are not millionaires. This is middle Ireland. They had a bit of comfort knowing that they did not have to face the expense of medicines and the doctor, regardless of what else had changed in their lives. God knows much has changed in the last year. They have seen their pensions obliterated on the international markets. They have seen the value of their investment disappear, and now they have the additional stress and worry of medical cards. They are also facing uncertainty over insurance, if they can afford it. Therefore, I vehemently oppose this section.
What consequences are there for those who do not hand back their medical card even though they are above the means test? I raised this question yesterday and I did not get an answer, but Deputy Shatter looked up the Act that refers to this and the fine is £50, which is €63. Maybe that is some comfort. What happens to people who find they are over the limit due to confusion, or due to failure to do tax returns until the end of the year? Will these people be charged the cost of the drugs they received during the year, or the cost of visits to the doctor? Self-employed people often do not know their situation until the end of the year. With the current expense of life and living, many people are continuing to work after 70. That is not something they necessarily want to do, but they must do so to maintain their living standards.
The Minister has heard enough from the people. She knows that they do not approve of this. She also knows that they do not approve of giving something and taking it back. As the old saying goes, "Give a thing and take it back; never see the eyes of God again". This will go down as the budget that took the medical card and universal right to that medical card away from the elderly. It is a retrograde social policy, because we should be travelling in the other direction. To say that we cannot afford to look after the welfare and health of our people, after ten years of a boom, is a damning indictment of this Government. It is a damning indictment of a Cabinet of 15 people that prioritises things in this way, of a Cabinet that puts fiscal rectitude ahead of people's health and security.
I must take issue with the Green Party, which stood for social inclusion and the lower classes. The Minister of State, Deputy Sargent, spoke in favour of all these things. Now he is part of a Government that is increasing class sizes, taking medical cards from the elderly and refusing to give a life-saving vaccine to young girls. It tried to take disability packages, including the disability allowance, from young children. The Minister mentioned earlier that more people are receiving home help this year. Can she tell the House how many hours of home help are available this year compared to last?
A smaller number of hours is being spread more thinly across a larger number of people. Many people have said that those who provide home help are just in the door, taking their coats off, when it is time for them to go again. It used to be a valuable service, but it is becoming a farce. Those who provide home help are not in people's homes long enough to do what needs to be done to keep patients safely at home. We will oppose this section, like many other sections of its kind. It is sad that the Government, in another section of the Bill, is proposing to take medical cards from people who have been widowed for three years.
We have started to deal with the substance of the sections of the Bill. It is a strange irony that one of the Government's main political acts in the second last week before the House adjourns for Christmas is to copperfasten the removal of medical cards from people over the age of 70. We should encourage those Deputies on the Government side of the House who are absent to participate in this debate. I have not seen any Green Party Deputy in the Chamber since the Committee Stage debate commenced. I presume Deputies Sargent, Ryan and Gormley are prioritising their obsession with growing Brussels sprouts for Christmas above the well-being of people who rely on medical cards.
This important section deals with the issue of eligibility. It links section 3 with section 4, which sets out the cut-off points that will apply. In supporting the approach being taken by Fine Gael and the Labour Party, which is to oppose the principle of the Bill and this section in particular, I wish to take a particular stand against the proposal, which is to come into effect on 2 March 2009, to deprive a number of those who currently qualify for the medical card from availing of this facility.
I would like the Minister, Deputy Harney, to answer some questions about the implementation of this section. What action does the HSE propose to take, following the enactment of the Bill, to ensure that the medical cards of those who are currently eligible for the card, but will be deemed ineligible from 2 March 2009, will be cancelled? Is it intended to send a cohort of HSE employees to knock on the doors of the elderly? Will the Government rely purely and simply on the self-assessment mechanism? The Minister might answer those questions.
In response to Deputy Reilly, the Minister should clarify whether the worst that can happen to existing medical card holders who do not inform the HSE after 2 March 2009 that they are no longer eligible for the medical card is that they might be prosecuted and fined €63 under the Health Act 1970. Does the Government intend to introduce a new penalty to deal with such people? Will the Government take civil action, to reclaim money spent on medicines and medical attention from doctors and consultants, against elderly people who inadvertently fail to communicate their ineligibility after 2 March next? What action will the Government take if such ineligibility is discovered a year or two later?
I listened carefully to what the Minister said about the advice of the Attorney General. I have expressed my views on the constitutionality of this proposal, as it affects married people who have been widowed. I ask the Minister to consider a very good point that was made by Deputy Barrett. Can she clarify the issue?
I do not believe the way this Bill affects widows and widowers is the only potentially unconstitutional aspect of it. The manner in which it treats spouses may also give rise to constitutional difficulties. Under this legislation, if a married couple has a collective gross income of €1,400 or less, both partners will get the medical card. Apparently it does not matter whether the partners are residing together or are separated — they will get the medical cards anyway.
Can the Minister clarify the position in the case of a separated or deserted wife who has a gross weekly income of €600 but whose husband, who lives elsewhere, has a weekly income of €1,000? Such a married couple — in this example, both of the separated people in question are over the age of 70 — would have a total gross weekly income of €1,600. If a woman in such circumstances wants to claim eligibility to the medical card on the basis of the principles of this Bill, her income will have to be amalgamated with that of her husband, even though they are living apart. In the case I have mentioned, their combined gross weekly income of €1,600 would exceed the limit of €1,400. That gives rise to constitutional problems. If the woman in question claims a medical card in the belief that the joint income of her and her husband is not more than €1,400, will there be a legal obligation on her husband to co-operate with the Department by furnishing information about his income?
What happens to a married couple, both of whom are over the age of 70, if one of them applies for a divorce and such a decree is granted after they have spent some time living apart? Special provisions are in place within our social welfare system to protect the social welfare rights of divorced people. That issue gave rise to a great deal of controversy when it was not dealt with adequately during the 1986 divorce referendum campaign. It had to be properly addressed in advance of the 1995 referendum. If both parties in a married couple qualified for the medical card before they got divorced because their joint income was under the €1,400 limit, what happens after the divorce if one of them exceeds the individual income limit of €700? Will such a person be deprived of his or her medical card on foot of the granting of a divorce? What will apply here? Has any thought been given to the application of this legislation for separated or divorced spouses?
In that context, it seems that unmarried people who are living together as a couple will get preferential treatment. If a man aged 71 is living with his 70 year old girlfriend, and they have a combined income of less than €1,400, both of them will qualify for the medical card. If the couple in question separates, the people in question will be treated individually. The man will be entitled to a medical card if his income is no more than €700. In such circumstances, the State would have absolutely no interest in the income of his former partner. Under the provisions of the Bill, before a determination can be made on whether a person over the age of 70 qualifies for a medical card, the State is required to show an obsessive interest in the income of that person's former partner if they were married. In effect, preferential treatment may be given to unmarried people in a series of circumstances, which I could further extrapolate for the benefit of the Minister.
I wager that the Attorney General's office has not given any thought to this issue. It is much more straightforward than the case of widows and widowers. If this legislation had been thought out properly, it would include special provisions dealing with the circumstances of separated married people and divorced married people. It would consider how a divorce decree would affect someone who was entitled to a medical card, on the basis of certain criteria, before he or she got divorced.
That aspect has not been addressed in the legislation. It is a gaping hole that has very serious constitutional implications. I still believe the issue of the widow and widower also has a serious implication. I bet that issue has not been considered. This is why we should not be taking Committee and Report Stages today. Taking Report Stage next week would give the Minister an opportunity to come back on that issue. I urge the Minister before we get to 6.30 p.m. to consider postponing Report Stage until next week to examine further those particular issues which are not adequately addressed nor have even been considered in the context of this legislation.
No legislation has caused as much anger among the elderly and their support structures as this has done. Only last week my secretary got an urgent call to help a couple — a man in his 80s and his wife in her mid 70s — fill in a form. My secretary could not understand what they were talking about it. The form turned out to be a medical card review form. Has that form been sent out to all over 70s? I understood nothing would happen on that until the Bill had been enacted. I have never been in a house where an aged couple were as greatly annoyed about anything as this particular issue. The man is a contributory pensioner who has worked all his life. They have a small amount of land that she looked after. They are scared about losing their medical cards. It is only when one witnesses it on the ground that one understands how serious it is.
I urge the Minister, even at this late stage, to rethink the proposal. While she might have already informed my colleagues, how much will the Government save? The Minister said in the House yesterday that 95% of all people over 70 would get the medical card. Will the savings from the 5% cover the total administration costs? What will the savings be in real money?
If we have all the exceptions that people are talking about and so many people are going to lose their cards, then the saving will be immense indeed. From what I am hearing, all kinds of people will allegedly lose their medical cards.
Section 3 is the heart of the legislation. We had a discussion earlier about principles and purpose. The essential purpose of the legislation is to withdraw the automatic entitlement to those who reach the age of 70 from getting a medical card and to re-establish an entitlement based on means. The second purpose of the legislation is to allow us to alter the capitation fee paid to general practitioners on foot of what was called the gold card introduced just over six years ago. That fee was negotiated and agreed on the basis of this legislation and can only be altered on the basis of this legislation, notwithstanding reaching agreements with organisations.
We were not and are not in a position in advance of changing the Competition Act, about which the Tánaiste spoke this morning, to negotiate with professionals in the health service on these matters. Even if one were, one would never be in a position, I assume — I would be interested in getting Deputy Reilly's views on this — to get 100% agreement. As Deputy Reilly knows, the contract is with each individual, notwithstanding how one might arrive at agreement on a fee. That contract with each individual general practitioner in respect of those over 70 who got cards based on their age was entered into on foot of legislation passed by the Oireachtas, which is why that needs to be changed too.
Regarding the issues raised by Deputy Shatter, as I said earlier, it is the practice that when a person with a medical card is widowed, regardless of age, the card is not withdrawn at that time and remains with that person until the card comes up for renewal. I wanted to ensure that we put it beyond doubt in the legislation. Other medical cards are given on the basis of an administrative arrangement rather than on the basis of the legislation. This was the only group of medical cards for which there is specific legislation, enacted by the Oireachtas in 2001.
Deputy Barrett asked about disposable and gross income. In 2005, I changed the general medical card regime to take account of disposable income to factor in travel to work costs, mortgage, rent, child care and so on so that we could target those who needed it most and that remains the position. Clearly there are three ways for people over 70 to get a medical card. They can get it on the basis of gross income in accordance with this legislation. They can get it under the general medical card scheme, which would take into account their net income. For example, a person with €40,000 per year nursing home care costs or perhaps other costs of that kind can apply under the regular medical card scheme. The third way is to apply for a discretionary card. The last information I got from the HSE indicated that approximately 70,000 people had such a card regardless of means because of a particular set of circumstances. It could be illness, outgoings or other factors that one cannot anticipate and put in legislation or even in an administrative scheme. That is done all the time. In my time in this House and the other House over the years I have personally helped people who have availed of that discretionary card because of particular circumstances they may have been going through.
Deputy Shatter advanced a view that I remember first hearing when both of us were members of Dublin County Council about whether cohabiting couples were eligible for the same housing entitlements as married couples and so on. I have not heard those arguments and I do not believe that is the argument he is making. I certainly hope not.
I am concerned about the discrimination against married people as opposed to objecting to——
It has been the practice for State benefits in the medical card area and in other areas like housing to treat cohabiting couples on the same basis as married couples for many reasons. In the early part of the new year I hope the House will deal with the civil union Bill which will address issues relating to same-sex couples and bring equality there. In all this we need to be conscious of the Equality Act and the Equal Status Act. Therefore, much as one may wish to do so, we are not at liberty to treat a widow or widower in a different way from a single person. If somebody never married and lived side-by-side with somebody who became widowed——
The problem is the Minister is treating a widow or widower worse than a single person and is also treating a separated or divorced spouse worse.
No. We are treating people, whether they are married or single, on the basis of income. It is exactly on the same basis. It is based totally on equality. The Deputy earlier claimed that what we are doing is unconstitutional. If that were the case, if a couple has a social welfare pension and one party passes away, the remaining party gets the benefit of that for a period of, I believe, six weeks. The same happens with tax law changes. All of these arrangements are based on the income of individuals. I am making provision for a three-year period. I would have wished it to be longer, but the advice of the Attorney General was that it was not possible that a widower or widow could have it for the entirety of his or her life and a single person could not have it on the same basis. The purpose of the amendment I will move later is to ensure we are not being discriminatory in those cases.
Regarding the deserted person, I assume the Deputy is talking about a person whose spouse has gone. We frequently deal with deserted people under the age of 70 who get medical cards based on their circumstances and that is how they are assessed. They are not assessed based on the circumstances of someone who is no longer supporting, living with or connected with that person. The normal arrangements that apply throughout the medical card scheme apply in those cases.
The specific arrangements that apply here do not address the position of separated or divorced people. I am not trying to be obstructive. Specific arrangements for means testing are laid down here. They do not address the dilemmas that arise if one is separated or divorced. I am not critical of the protection the Minister is giving unmarried couples, I am merely explaining that an unmarried person who separates has greater protection than a married or divorced person under the peculiarities of the new means testing rules applicable to the over 70s on this scheme.
My advice is different. I will clarify it shortly. Somebody on €600 per week who lives alone having been deserted or abandoned, or whatever the case may be, will be eligible. I know somebody aged approximately 67 who is not in a dissimilar position and she has a medical card.
Under this scheme, as the Minister has laid it down in statute, meaning the HSE will have no discretion, the income of a married couple is treated together as one gross sum. As Deputy Barrett correctly pointed out, there is no provision that allows individualisation and as a consequence, an abandoned wife who has an income of only €600 gross can be rendered ineligible for a medical card because the husband who has abandoned her has an income of €1,000 gross.
A few moments ago I explained in response to Deputy Barrett that there are three routes for an over 70 year old to get a medical card. There is the route based on gross income, the discretionary card and the net income position, which covers situations where people have nursing home charges etc.
Could the Minister give way for a moment?
Please allow the Minister to finish her point. I will return to Deputy Barrett.
People have medical cards based on their financial circumstances and weekly incomes, for single people €700 per week and for married people €1,400 per week. Anybody who does not qualify on those grounds has the same routes available to people under the age of 70, including somebody aged 68 or 69. This provision was introduced in 2001 when the country's circumstances were very different. The parties opposite did not bring in a provision to give over 70s medical cards when they were last in government because the economic circumstances did not allow it. Today's economic circumstances are very different from those in 2001, as everybody here will acknowledge.
This is not a case of fiscal rectitude coming before the elderly. Fiscal rectitude is a means to an end, the end of generating the economic wealth to allow us to have better health and education services and welfare provision. Health expenditure accounts for 30% of the money we spend running this country. The percentage expenditure increase in health next year is the lowest in ten to 12 years because of our economic circumstances. We want to maintain home help hours, which increased by 3% in 2008 over 2007; continue delivering home care packages to those who need them most, based on medical or clinical need, to allow older people to stay at home; introduce the fair deal to help those who are really strapped trying to pay for nursing home care, as everybody here would acknowledge; and maintain as many services as possible at primary, community and continuing care level and at hospital level. To do this we need to make choices and in that context the Government made this decision in budget 2008.
The cut-off point under which people pay the lower tax rate of 20% is €700 per week. The Government announced it was restoring the medical cards to people over 70 with the exception of the "super rich". If one has an income that matches the tax regulations that allow one to pay tax at 20%, up to €700 per week, one is not part of the super rich in this country. Let us dismiss that myth. My point, in addition to the points Deputy Shatter followed on with, is that individualisation exists in the tax code. A married couple can be taxed on an individual basis. In this matter a married couple cannot be assessed on an individual basis, which totally contradicts the Government's position on the tax law.
A married couple can have all sorts of circumstances. Why can a woman, in particular, who has reared a family and is discriminated against in the tax code, not use the convenience of being an individual in her application for a medical card? Why can she not declare she does not have an income like her husband's, although she lives with him. We do not go into her family circumstances and poke around to find how much she receives per month or week from her husband. If she declares she has no income and is aged over 70, why should she be penalised because her husband's income is €1,400 per week?
We do not know whether the husband gives her anything. Does she get any pocket money? What does she do? Does he prevent her from going to the doctor because he will not pay the fee? We do not know these circumstances. In legislation it is not good enough to say she can go to the community welfare officer and plead hardship, saying she has a nasty husband. The Minister is putting down in law gross income of €1,400 for a married couple and €700 for a single person. We are entitled to ask why, in these circumstances, a married person, whether the woman or the man has the income, cannot apply on an individual basis for a medical card based on his or her nil income. That matter must be dealt with because it will arise.
The women of Ireland, who have been treated badly by the tax code because of individualisation, particularly the married women who have chosen to spend a life at home rearing children and looking after the home to the benefit of the State, should not be deprived of a medical card in the latter years of their lives and should not depend on getting a few quid from their husbands to be able to visit the doctor. Let us clearly state the rights of individuals in certain circumstances. Can a married woman apply on an individual basis and qualify on the grounds that she has no income in her own right? Yes or no?
I will begin with the point Deputy Barrett has explored. The children's allowance, which is universally available, is given to the mother for the reasons to which Deputy Barrett alluded, that sometimes all is not as it seems in households. A woman may, ostensibly, have the use of her husband's income but may in fact not, and may not be treated properly. That is why the children's allowance is always given to the mother, lest such a husband use it for purposes other than those for which it was intended. I do not denigrate all the married couples in this country, the vast majority of whom provide happy families in which to grow up but we know of instances to the contrary; social workers tell us of them and they are not numbered in tens or hundreds.
I return to what the Minister said a few moments ago about having to make choices and her comments on home help services and operations. Operations are being cancelled up and down the country. We want the Minister to go after the waste she acknowledges exists in the HSE, address the redundancies and retraining in front line services required and sort out the top-heavy administration and management. That is where the money can be saved.
I have already told the Minister that in the North of Ireland waiting lists were reduced from 57,000 to zero over 18 months, and money was not the issue. Perhaps some additional money was spent, but very little. The difference was that the relevant Minister took direct responsibility and formed a special delivery unit that went into hospitals to find out why waiting lists were long, provided solutions, and then reported back on a weekly basis — sometimes a daily basis — to the Minister about the progress in hospitals. Such a system leads to two things. It puts pressure on those in the hospital to perform, because they know the Minister is looking at them. However, unlike here, they also feel the Minister is behind them and not at a remove, which has been the effect of much of the Minister's recent legislation. It puts distance between her and her responsibilities.
I am saying to the Minister that she should go after the waste and not go after the over 70s. They worked hard, they are the people who paid the 60% tax, who left this country, worked abroad, came back and built this country into what it is today. They have asked for very little. They are the people who save their money — the people who, as other Deputies mentioned, made their own sandwiches rather than buying them.
I mentioned earlier the longitudinal study that was carried out, which the Minister questioned. I have before me the documentation for the study, which is called Health and Social Services for Older People, HeSSOP. HeSSOP I was done in 2000 and HeSSOP II was done in 2004. HeSSOP II studied a different cohort, but 300 of the people from the first study were also followed up. The study, according to the National Council on Ageing and Older People, incorporates the first longitudinal data on older people in this country. It was carried out in two health board areas, the Eastern Regional Health Authority and the Western Health Board. The study gave grounds for optimism about the health of older people, including a reduction in smoking among older people, and a much greater uptake of flu vaccinations — from 30% to 70%, which represents more than a doubling of vaccine uptake. This is very important because it reduces the risk of stroke and heart attacks among the over 70s by 16% to 30%, which is a major saving by anyone's measure and a major health gain. I am not talking just about big savings to the State but also to people in terms of suffering and pain.
The study also noted that the gains were less in the 65 to 70 year old age group, who do not have universal access to medical cards. An article written by a GP concluded that better access to health care for the over 70s resulted in better use of preventative cancer screening. The study is real and the facts are there, yet the Minister chooses to ignore them to pursue, for whatever bizarre reason, this idea that removing medical cards from the over 70s will save us money in the longer term. In the longer term it will probably cost us more money in admissions, in accident and emergency services, in long term care. It goes completely against the principle, as espoused by the Minister and Professor Drumm, of trying to keep people in their homes and out of hospital. What will happen? The Minister knows what will happen. People will wait; they will hang on. They will not go to the doctor. They will not buy the medicine. They will chance another day and then another day, and they will end up in hospital, costing the State and themselves a lot of grief.
I have a quote here from Dr. Shaun O'Keeffe, who is the chairman of the Irish Society of Physicians in Geriatric Medicine. He states: "The decision eight years ago to extend the medical card to all over-70s was an enlightened and cost-effective measure". The only thing I can say about that is that it has transpired to be very cost-effective and enlightened even if at the time it was a political stroke to win the grey vote. I said to the Minister earlier and I will say again, "Give a thing and take it back; never see the eyes of God again". I will tell the Minister one thing. She will not see the votes of the elderly again.
I do not propose to go back over all the issues again but I do want to raise one issue the Minister mentioned, which is the use of the term "gross" when referring to incomes, as opposed to "net". Section 3 specifically states: "so long as the person's gross income does not exceed the relevant gross income limit under section 45A". In response to a specific point I made about somebody who sold their house in order to afford nursing home charges, the Minister said that person could apply under the other means test, which is based on net income and allows for certain expenses. The income limits are lower if one applies under that system. My point is with regard to how gross income is defined. As I read the Bill it seems the only things excluded are in section 4, which lists things such as compensation under the hepatitis C tribunal. There are four or five different exemptions in that regard.
I have a letter here from a pensioner who makes a good point. He writes:
Each pension cheque shows three main figures — (1) the gross figure (which one does not receive); (2) the figure for the compulsory PAYE income tax amount (which one does not receive, because it is not your income but the Government's — one never sees it, it is deducted compulsorily at source); (3) the figure for the income you actually get (the gross figure at (1) less the Government income figure at (2)).
This income figure at (3) above is the real gross figure [you] actually receive in your hand and I respectfully suggest should be the one used in the income limits for the recently announced means test for the over-70s [medical] card. To use the unamended gross income figure alone (a gross income we pensioners do not receive) would be very unjust, I feel. The substantial tax portion of that gross figure is Government income, Government property, over which we have no choice — it is no longer the income of the pensioner.
He goes on to appeal "to have this relatively small amendment implemented as outlined above". I read this out because it makes a very fair point. In effect, the real gross figure should be the one after the Government's portion has been taken out, because the pensioner has no discretion whatsoever with regard to the top figure on his or her pension. The Minister will be taking the Bill in the Seanad and it is too late now to propose an amendment that would do that. In any event, it would be ruled out of order for the same reason Deputy Reilly's amendments were ruled out of order — because it would impose a charge on the State. However, I raise it here because it is a valid point. Perhaps the Minister will consider it.
I do not want to be overly political in the debate, although I suppose it is a rather political debate, but I mentioned this to Deputy Reilly earlier and I will say it again. Deputy Reilly says that he changed his mind based on evidence. A year ago next Sunday Deputy Reilly said to a respected journalist that a means test should be introduced. I am not making a big issue of it, but there is no point in the Deputy coming in here and saying all has suddenly changed.
I was not aware of these reports then.
I will tell the Deputy about a few reports. We mentioned life expectancy earlier. Between 1966 and 1996, people aged 70 added one year to their average lifespan. In the ten-year period between 1996 and 2006 this increased by two years. We have doubled our performance — in fact, it improved six-fold, because that was over a ten-year period as opposed to a 30-year period. Among the reasons for this are enhanced prosperity and reductions in strokes, heart disease and so on as a result of better interventions. Successive Ministers, including the Leas-Cheann Comhairle, Deputy Noonan and many Deputies from the Fianna Fáil Party who have preceded me since 1997, have invested heavily from taxpayers' resources in better treatments, and this is paying dividends. There is no doubt about that. The increase in life expectancy which I mentioned earlier means that somebody aged 70 can now expect to live 12.8 more years in the case of a man and 15.7 years for a woman, as opposed to 10.6 and 13.7 years respectively, which were the previous figures. It is a dramatic improvement and we all welcome that.
Absolutely.
Much of it — 60% — is to do with better health interventions.
With regard to visits to general practitioners, the evidence, including the SRI survey, shows that a person over 70 who has free medical treatment, if one wants to use that phrase, goes once more often per year than somebody who does not. The average attendance was 5.2, which increased by one visit per year.
Equally, it is the case that many of the people who are currently in our acute hospital system in this city and elsewhere, who should be in long-stay accommodation or perhaps with a home care package — I hope when we introduce the fair deal scheme they will be in long-term care — are people with full medical cards so that does not prove anything. The fact that a person has a medical card which entitles him or her to see the general practitioner without payment and get drugs without payment does not mean that people do not end up in hospital. Deputy Reilly knows that to be the case.
Nobody said that.
There was an implication——
——increased access to the flu vaccine; it was stated clearly.
I agree they are all important issues.
I want to deal with the issue of income. First, I will deal with one more item, the waiting times for procedures in comparison with Northern Ireland.
To do with gross income.
I will deal with that. The National Treatment Purchase Fund published results today and they show a dramatic improvement. The number of people waiting for procedures is down 60% on this time last year. The waiting time for operations in respect of public patients is now an average of 2.9 months.
A total of 50% of them are waiting longer than six months; that information is also provided, with no mention of the waiting time to get to see a consultant to get on a waiting list.
I agree that is an issue.
It is seven and a half years.
That is an issue and that is why——
This is all very interesting Minister.
I am responding to a point made earlier about Northern Ireland.
I allowed latitude on both sides to deal with it but we are in a confined debate and I ask Members to focus on section 3.
I apologise, Leas-Cheann Comhairle. I assume we are dealing with that issue too.
With regard to the individualisation of assessment, Deputy Barrett is correct that individualisation exists in the taxation system. It was introduced in 1998, I think, and at the time it was quite controversial. One of the reasons for its introduction was to encourage married women in particular back into the workforce and to avoid them hitting the marginal rate of tax on everything they earned. It was highly successful and is generally seen to be fair.
We have to, and have begun to move on the question of pensions and dependant allowances, particularly for women. It is the case that many older women opted out of the workforce to look after their children and do not have pensions in their own right and are very dependent on their husbands. We have moved in recent years to increase the pension paid in respect of a dependent spouse. I look forward to further progress in this direction.
For the purposes of medical cards, this has an up side as well as a down side. For example, a younger person of 40, 50 or 60, who is married to an older person, will also get a card if the older person qualifies. For medical card purposes, the family benefits if the card is given, with the exception of the discretionary card which is granted in many cases on the basis of the individual's particular circumstances. It could be because somebody is terminally ill, is undergoing particular treatments, out of work or for whatever reason. These people are treated on an individual basis. However, in general we deal with families. If a husband qualifies, the wife tends to be given the card and vice versa. The same applies here. This is the reason a couple is being assessed.
Deputy Shatter mentioned anomalies such as desertion and provisions in the Social Welfare Bill, which I will discuss that with the Attorney General. However, the provisions in the Bill will exclude very few old people. I refer to a reply to a parliamentary question asked by Deputy Jan O'Sullivan with regard to the latest information on income for those aged 65 and over and those aged 70 and over. A total of 80% of people aged 70 or over have an income of €446.98 a week. Some 95% of the population will be unaffected in these circumstances.
I reiterate we are removing the automatic universal entitlement. I do not believe that somebody in my circumstances or those of most of us here should be entitled to a medical card when we know that a couple aged 69 or 68 with an income of only €298 per week is not. We would like to be more generous and I wish if resources permitted we could have been more generous but unfortunately we are not at present in a position to do so, particularly with regard to next year.
The Minister's Government introduced it.
I accept that but the circumstances then were very different. With the demographic and financial position in which this country finds itself, it is not financially sustainable without substantially reducing other services and therefore being unable to provide for those who will become unemployed and in need of medical cards during 2009.
Question put.
The Committee divided: Tá, 74; Níl, 62.
Tá
- Ahern, Bertie.
- Ahern, Dermot.
- Ahern, Michael.
- Andrews, Barry.
- Andrews, Chris.
- Ardagh, Seán.
- Aylward, Bobby.
- Blaney, Niall.
- Brady, Áine.
- Brady, Cyprian.
- Brady, Johnny.
- Browne, John.
- Byrne, Thomas.
- Calleary, Dara.
- Carey, Pat.
- Collins, Niall.
- Conlon, Margaret.
- Connick, Seán.
- Coughlan, Mary.
- Cregan, John.
- Cullen, Martin.
- Curran, John.
- Dempsey, Noel.
- Devins, Jimmy.
- Dooley, Timmy.
- Fahey, Frank.
- Finneran, Michael.
- Fitzpatrick, Michael.
- Flynn, Beverley.
- Gogarty, Paul.
- Grealish, Noel.
- Hanafin, Mary.
- Harney, Mary.
- Haughey, Seán.
- Hoctor, Máire.
- Kelleher, Billy.
- Kelly, Peter.
- Kenneally, Brendan.
- Kennedy, Michael.
- Kirk, Seamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lenihan, Brian.
- Lenihan, Conor.
- Lowry, Michael.
- McEllistrim, Thomas.
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- Mansergh, Martin.
- Moloney, John.
- Moynihan, Michael.
- Mulcahy, Michael.
- Nolan, M.J.
- Ó Cuív, Éamon.
- Ó Fearghaíl, Seán.
- O’Brien, Darragh.
- O’Connor, Charlie.
- O’Dea, Willie.
- O’Flynn, Noel.
- O’Hanlon, Rory.
- O’Keeffe, Batt.
- O’Keeffe, Edward.
- O’Rourke, Mary.
- O’Sullivan, Christy.
- Power, Peter.
- Power, Seán.
- Ryan, Eamon.
- Sargent, Trevor.
- Scanlon, Eamon.
- Treacy, Noel.
- Wallace, Mary.
- White, Mary Alexandra.
- Woods, Michael.
Níl
- Allen, Bernard.
- Bannon, James.
- Barrett, Seán.
- Behan, Joe.
- Breen, Pat.
- Bruton, Richard.
- Burke, Ulick.
- Burton, Joan.
- Carey, Joe.
- Clune, Deirdre.
- Connaughton, Paul.
- Coonan, Noel J.
- Costello, Joe.
- Crawford, Seymour.
- Creed, Michael.
- Creighton, Lucinda.
- Deasy, John.
- Deenihan, Jimmy.
- Doyle, Andrew.
- Durkan, Bernard J.
- English, Damien.
- Feighan, Frank.
- Flanagan, Terence.
- Gilmore, Eamon.
- Hayes, Tom.
- Higgins, Michael D.
- Hogan, Phil.
- Howlin, Brendan.
- Kehoe, Paul.
- Lynch, Ciarán.
- Lynch, Kathleen.
- McEntee, Shane.
- McGinley, Dinny.
- McGrath, Finian.
- McHugh, Joe.
- Mitchell, Olivia.
- Morgan, Arthur.
- Neville, Dan.
- Ó Caoláin, Caoimhghín.
- Ó Snodaigh, Aengus.
- O’Donnell, Kieran.
- O’Dowd, Fergus.
- O’Mahony, John.
- O’Shea, Brian.
- O’Sullivan, Jan.
- Penrose, Willie.
- Quinn, Ruairí.
- Rabbitte, Pat.
- Reilly, James.
- Ring, Michael.
- Shatter, Alan.
- Sheahan, Tom.
- Sheehan, P.J..
- Sherlock, Seán.
- Shortall, Róisín.
- Stagg, Emmet.
- Stanton, David.
- Timmins, Billy.
- Tuffy, Joanna.
- Upton, Mary.
- Varadkar, Leo.
- Wall, Jack.
Tellers: Tá, Deputies Pat Carey and John Cregan; Níl, Deputies Paul Kehoe and Emmet Stagg
Question declared carried.
SECTION 4.
Amendments Nos. 4 and 5 are related and will be discussed together.
I move amendment No. 4:
In page 4, to delete line 31 and substitute the following:
"(b) persons who were married to another person until that other person’s death, or lived with that other person as husband and wife until the other person’s death—
(i) if the surviving persons have attained the age of 70 years at the time of the death,
(ii) if the death occurred on or after 1 January 2009, and
(iii) for a period of 3 years after the death, so long as their gross income does not exceed the gross income limit set out in paragraph (b) of subsection (2) during that period;
and".
One of these amendments is technical and the other puts beyond doubt a situation that generally exists in practice. On the death of the spouse of persons aged over 70, they will hold the medical card for a period of three years. During the earlier debate I said that I wished that this could continue for longer but, on the advice of the Attorney General, we cannot introduce discriminatory provisions between widows and widowers and single people. The gross income will be the income of the widow or the widower for a period of up to three years following the death of a spouse. Amendment No. 4 concerns this and amendment No. 5 is consequential on it.
Why is it only possible to continue this for three years? What is the regulation or legal concern?
I was going to ask that question. I do not understand why that is the cut-off point. This is an improvement to the Bill as published for a small section of the population for three years. To that extent we will not oppose this because we would make the Bill worse than it will be at the end.
If the spouse dies before 1 January, if someone loses a husband or wife over the Christmas period before the new year, the person will not keep the card for three years. It only applies if the husband or wife dies after 1 January. I do not know if anything can be done about this but it seems harsh. If the person dies before 1 January, the card is gone on 2 March. If the person dies on or after 1 January, the card is kept for another three years. I do not know if it is possible to have a sliding scale but it seems particularly harsh.
Deputy Shatter and others have referred to the discrimination we are introducing between certain widows and widowers, depending on what date the person was widowed. It seems it is a discrimination that could be questioned legally or constitutionally. There is a different rule for widows and widowers who are in the same circumstances apart from the date on which they were widowed.
The medical card scheme is generally on an administrative basis with the exception of the 2001 Act relating to those over 70. Notwithstanding that, the practice is that when someone under 70 becomes a widow or widower the card is left with the person until the card has to be renewed.
The reason for the amendment applying from 1 January is that all these provisions apply from 1 January. I am not in a position to make it retrospective in advance of 1 January. The current practice of the HSE will continue on an administrative basis and the HSE will take all reasonable measures to ensure people in this position are not put at a disadvantage on the immediate death of the spouse.
Is the Minister saying that any medical cards issued under this provision will only have a three year life span and that medical card holders will be required to submit details of eligibility? Can the Minister explain the position of people over 70 who currently have the medical card as a universal right under the existing legislation? This is relevant to widows, widowers, those with a spouse alive and single people but we are dealing with widows and widowers here. What is the position of these people? How many cards have been issued that have not been specified to expire by any particular date? What arrangements are being made to withdraw those cards if there is a suspicion of ineligibility in circumstances where there has been no communication after 2 March?
The Minister referred to the specifics of an administrative arrangement that the HSE applies to the means-tested medical card, as opposed to the card being granted to over 70s or being granted on a discretionary basis. The Minister can correct me if I am wrong. The Minister referred to advice from the Attorney General. I am not aware of any legal basis on which the Minister is compelled to remove a medical card from a widow or widower three years after suffering the bereavement of a spouse. Can the Minister identify the legal principle that says the medical card must be removed from the widow or widower three years after the spouse dies? Does something indicate that it must be three years rather than two, four or five years? I am unaware of that.
Is it based on some perceived theory of political correctness, as opposed to a legal principle, with regard to unmarried individuals? Widows and widowers are recognised in our law and, in a number of areas, they receive additional benefits over and above what unmarried individuals receive. This is because they are widows or widowers. Can the Minister confirm there are some exceptions to what the Minister is now proposing? Can she explain the social policy basis and the moral basis of the exceptions? Based on what is proposed, if I am 71 and I have qualified for the medical card under this scheme and my wife of 70 dies, I will retain the medical card for three years and, after three years, I may lose it. I will not lose it if I find another woman who is willing to reside with me and whose income, if grossed with mine, will not take us beyond the €1,400. That is, if she is willing to live with me as husband and wife. Is it part of the departmental social policy that widows and widowers over 70 place advertisements seeking unmarried or widowed individuals to reside with them just before they get to the cusp of the third year? What is the social policy thinking? Presumably they would be living as husband and wife cohabiting with a third party. I do not understand the social policy basis of that.
If the Government is intent on introducing equality legislation with regard to gay couples, why would the Minister exclude the case where a woman who has been widowed within the three year period arranges for another woman to reside with her for companionship? Why are they excluded from having income grossed up to allow them to qualify for the medical card? Can the Minister explain the social basis for that?
If I had a brother, which I do not, and my wife passed away and I had qualified for the medical card, if I was 71 and my brother was 70, if my brother moved in with me and our gross income did not exceed €1,400, what would be the social basis for denying us the medical card? Qualification for the medical card is based on the fact of people over 70 engaging in sexual intimacy. Is that the social basis and is that the principled social policy we are advancing to justify the peculiarity of the rules being applied?
I refer to the latter issue first. A brother and sister cannot apply for an old age pension or any other social welfare benefit together. I do not mean to be smart but we operate on the basis that families are recognised for the purposes of medical cards. When a member of a family qualifies for a medical card, the spouse and the children are included on the card. When the automatic entitlement was introduced for the over 70s, even where a spouse was substantially younger, by perhaps 20 or 30 years, although this was exceptional, they were entitled to a card as well without reaching the age. That was done on the basis that we could not interfere with families and, therefore, the card was granted to both the husband and the wife. No one would argue two brothers or two sisters should be considered a couple for the purposes of acquiring a medical card. They would be considered on an individual basis.
I refer to the three-year provision. I would have wished that a widow or widower could have retained the medical card indefinitely on the death of the spouse but the strong advice from the Attorney General is that is not legally sustainable and we are not free to discriminate between somebody in that position or, for example, somebody who never married, which is understandable. I was advised three years is a reasonable period. It is neither indefinite nor lengthy but it is reasonable and that is why that provision is being introduced on the basis of legal advice. It has been suggested many times that, immediately on the death of a spouse, the medical card would be whipped away. The HSE's practice is to leave the card with the surviving spouse until it expires.
The practice regarding the expiration of cards differs throughout the country and it is being standardised. Generally, cards are renewed on a yearly basis but older people who are out of the workforce can renew the card sometimes every three years. The validity of a card is based on the legislation and not on the date written on it. That is why it was necessary to amend the legislation to change the capitation fee paid to GPs, which was negotiated on foot of the legislation, and to reintroduce the new basis on which medical cards will be granted to the over 70s. I have heard of examples of dates far hence written on cards. If people felt they were entitled to a card on reaching the age of 70 and had a date put on it, that was not good from a psychological point of view but the date printed on cards varied from place to place. One Member stated 2020 was written on a medical card. However, the basis on which people retain cards is the legislation and the date on the card does not matter.
Given we are in the Christmas period, the HSE will communicate with the over 70s to explain the new arrangements. From 1 January, new cards will be granted on the basis of self-assessment. The vast majority of older people are honest, perhaps more honest than other generations. For example, 60% of those entitled to repayments in lieu of public nursing home charges did not apply and did not want a refund. Many people said they were happy with the care they received or, in some cases, people were happy with the care their parents received and they did not want the money back. I do not say anyone who sought the return of their money was not fully entitled to it but I am impressed with the number of people who decided not to do so. That indicates the self-assessment process will work.
Like all health schemes, under this scheme, if people receive a benefit to which they are not entitled, the normal arrangements will apply and the HSE will be able to discontinue the card under the 1970 Act and it may charge people for services to which they are not entitled free of charge. I do not anticipate that many older people will be dishonest regarding self-assessment. The State has at its disposal access to contact with Revenue authorities, the Paymaster General and so on about earnings. Deputy Reilly asked how many people aged over 70 are working. I do not suspect there are many but, generally, such people are in receipt of occupational pensions. We are excluding approximately 5% of people in this age group under the legislation. Individuals may face difficult circumstances relating to nursing home costs. I was contacted recently by an individual with high nursing home costs of approximately €50,000 a year and, notwithstanding the fact the individual's income is outside the €700 weekly limit, the individual will benefit from the regular medical card, which is calculated on the basis of net income because all those costs are factored out.
If widows or widowers who are qualified under the scheme for a medical card commence residing with someone else of the opposite sex within three years of the death of their spouse, what investigation will the HSE conduct to determine whether such couples are residing together as friends or as husband and wife? The Minister referred to the Revenue, the State's capacity to check people's income, the assumption of honesty and people providing the details of their income to the HSE following 2 March 2009. What steps will the HSE take to investigate the financial circumstance of people aged over 70? What State resources will be spent on that exercise? What is the projected cost of the HSE dealing with the returns it receives following 2 March 2009 when dealing with the financial eligibility criteria?
Where people aged over 70 have made returns and they fall outside the income limits because of the gross rules that apply, has a direction been issued to the HSE by the Department or does the Minister propose to issue any to emphasise the fact that people who fall outside the eligibility test based on gross income should nevertheless have their cases examined by the HSE to ascertain whether they qualify for the medical card under the net income tests that are applied? The Minister used the example of someone paying €50,000 a year in nursing home fees, although no one in the State should be placed in that position. However, if that person makes a simple return based on gross income, he or she will be deemed ineligible. People may not know that once they are deemed ineligible, they might qualify under the general means test rules. What positive action will the HSE take to ensure those who may be otherwise entitled to medical cards but who fall foul of the new regime will have them made available to them? What active steps will the State take in that regard?
With regard to the means tested card, what level of means test will apply? At present, there is no means testing for those aged over 70 as they are all entitled to it as a matter of right. I know those aged under 70 married to someone aged over 70 are means tested. Will the Minister clarify what will be the income limit for a medical card before expenses are taken into account in the existing means test as opposed to the new gross test?
With regard to Deputy Shatter's question it is not envisaged that any additional personnel will be required. Next year, as the Deputy is aware, the intention is to advance a redundancy programme within all levels of the HSE, beginning at the administrative management level and the GMS and it is understood there is scope there, as there is elsewhere.
The application process will be greatly simplified. The current application process, particularly for older people is unnecessarily long, as are official forms generally. With regard to what steps will be taken, we know the number of older people who pay tax and file returns on an annual basis. We have this data and if memory serves me right approximately 40,000 people over the age of 70 pay tax and many of them do so at the standard rate as they have relatively low earnings and age exemptions and additional benefits apply which relieve older people of tax liability.
With regard to the question from Deputy Reilly, a couple will have a net limit of €298. If one had a bill of €50,000 for a nursing home and other expenses which may be unusual and which we have not envisaged all of these will be factored out. At present the net limit for a person aged between 66 and 69 is €298. With regard to the nature of the means test for those aged over 70, it will be a simple application form. Everybody will be written to and the new provisions will be explained including the information on net positions, gross income and outgoings. While we want to keep the letter as simple and short as possible we also want to ensure we explain the situation.
I know from my constituency work that at present if a person applies for a doctor only medical card he or she is assessed for a full card. The HSE is required to carry out an assessment and ensure one gets what one is entitled to. Under this Bill the HSE will be obliged to help older people and this will be made clear in communications to older people. I presume general practitioners will also be informed so they can advise their patients on assistance that will be forthcoming.
The Minister did not deal with the issue of a widow or widower who has someone else come to reside in the home within the three year period. What type of investigation is it intended the HSE will carry out to determine whether they are living together as husband and wife?
I do not think too many people over the age of 70 who are widowed will put an advertisement in the newspaper to suggest that someone comes and lives with them so they can keep their medical cards. I do not believe such a scenario exists. The onus in the application process rests with the older person. It is a simplified self-assessment. The HSE must use the provisions it uses at present and not only with regard to this group of citizens as other authorities do. It is not the case that older people do not communicate with the authorities. Those with a taxable income, and we are discussing only those who have a taxable income, must file returns.
Every two years, the Department of Finance and the Paymaster General communicate with pensioners, whether they are teachers, doctors, civil servants or Members of this House, to certify their circumstances. Recently, I saw a letter in a teacher's house in which confirmation was requested that the person was still there and alive.
The person answered "No", I presume.
I remember thinking that someday we will all receive such a letter. A person is entitled to the pension and the purpose of the letter is not to confirm circumstances with regard to one's earnings. It is simply to receive a response so a payment is not being made to a person who has unfortunately passed away and the authorities are unaware of this. This is done for all State occupational pensions.
The documentation in the communication will be as simplified as possible to make it easy for older people and their families. There is a provision in the Bill to ensure the HSE is required to help the person with their application process if the person so wishes.
With regard to the Minister's response to Deputy Reilly's question on income guidelines for somebody who applies in the old-fashioned way rather than based on the limits of €700 and €1,400, this would not be done under the Bill but through the administration of the HSE systems. Prior to this, we operated under the HSE income guidelines of June 2006 because no increase has been made since then. This included a system of progression as one got older and I want to bring this to the Minister's attention.
I have the figures to hand. Guidelines were provided for single people up to the age of 69 because a person over 70 received the card automatically. Guidelines were also provided for married couples where one person was over 70. These income limits increased as a person aged. Prior to the budget, the guidelines for people aged between 70 and 79 was €596.50 and for those aged over 80 it was €627. I do not suggest that the Minister provides an answer on this today but where somebody uses the old-fashioned system because they have major expenses and they want to use a net rather than a gross figure will the Minister operate this principle of increasing the limits as the person gets older? I hope the Minister understands the point I am making. It was always a principle in the system and I would not like to see it go.
All guidelines with regard to this age group will have to be amended in accordance with the new legislation. Prior to Christmas it is my intention to meet, along with my officials, the HSE and those who operate the GMS to discuss the communications to older people and general practitioners and the guidelines will be raised also.
I was interested to hear the Minister state she would have preferred to have left in place a position whereby widows and widowers who already had the medical card would be allowed to retain it under this scheme. I disagree with the legal advice the Minister was given. Based on the provisions contained in the Constitution relating to the family based on marriage there was no difficulty of a legal or constitutional nature in her so doing. I do not believe it was necessary to make provision that a widow or widower only retain a medical card for three years from the death of his or her spouse. This is a particularly unpleasant provision to include in the legislation.
If the Minister wants to consider it in age terms, albeit based on the Minister's statistical information that small numbers are involved, a widow or widower who may have retained a medical card well into his or her mid 70s, late 70s or even early 80s — it is individuals in the later years of their lives who are all likely to have some form of health difficulties — may find under this provision that having had available to them a medical card the State will take it back from them and this is a most cruel and inappropriate step.
I listened with interest to the statistics given and the references to only 5% of those who are over 70 being affected by the scheme based on the information available to the Department. I am conscious that when this scheme was introduced in 2001 the Department was wildly inaccurate in its projections as to the numbers who had a claim under it. Substantially more did so than was originally projected. I have no confidence in the information the Minister has on the numbers affected by the new proposals.
I do not accept the legal advice the Minister is relying on in claiming that she is compelled to remove the medical card from widows and widowers three years after the death of their spouse. Who would even initiate a court challenge to withdraw the medical card from widowers and widowers in such circumstances? I cannot envisage that happening. Nor can I envisage, given the provisions of Article 41 of the Constitution, any unmarried person over 70 years of age succeeding in persuading the courts that it was wrong of the State to make additional provision for widows and widowers. I do not believe the Minister's advice in this regard is correct.
There is no legal term of art that requires that provision be withdrawn within three years. If the Minister felt the need for some odd constitutional reason, which I do not accept, to provide some time limit, it could just as easily have been set at five, six or seven years. The time limit of three years seems entirely arbitrary and I do not accept that it has any particular validity with regard to any legal principle. Nevertheless, I welcome the Minister's recognition of the need to change the legislation, because I do not accept what she said earlier in this regard. Clearly, as this legislation was originally framed, people could become instantly ineligible for the medical card upon the death of a spouse. Regardless of the administrative practices of the Health Service Executive in regard to dealing with medical cards and other circumstances, it would have been required to apply this legislation. I welcome that change but I do not believe it was necessary to confine the provision to three years following the death of a spouse.
I agree with Deputy Shatter that a court challenge to the provision of a medical card to a widow or widower is unlikely. That is not the issue. The concern is that a single person might initiate legal action to the effect that he or she is being discriminated against on grounds of receiving different treatment to that afforded to widows and widowers.
Such a challenge would not succeed.
That is the advice we have received. We have been further advised that a period of three years is reasonable and that a longer period or an indefinite period might be subject to serious legal challenge from people who never married. Consider the case, for example, of two neighbours, one a widowed person with an income of €1,300 per week and the other a single person with an income of €750 per week. In the absence of a time limit as provided for in the Bill, although the second person is not eligible for a medical card, the first would be entitled indefinitely to retain it. That is the scenario we are seeking to address in this amendment. I would have wished to do what the Deputy is suggesting but it was not legally possible for the reasons I have indicated.
I reiterate that the data indicate that only 5% of persons aged over 70 years will be affected by the proposals in the Bill. These data were set out in the reply to a parliamentary question yesterday from Deputy Jan O'Sullivan. This information does not come from the Department of Health and Children but is rather the most up-the-date information available from the Central Statistics Office, Revenue Commissioners and so on. The information we received from the Revenue in the context of the budget indicated that there are approximately 40,000 people aged over 70 who pay income tax, many of whom have earnings far below €1,400 per week in the case of a couple. Approximately half of them will no longer qualify for a medical card under the new scheme unless they qualify based on net income where, nursing home and other medical costs being taken into account, their net position is no greater than €298 per week for a couple, the same threshold that applies for couples aged between 65 and 70.
Amendment agreed to.
I move amendment No. 5:
In page 4, line 32, to delete "(b) dependants of the persons referred to in” and substitute the following:
"(c) dependants of the persons referred to in”.
Amendment agreed to.
I move amendment No. 5a:
In page 4, between lines 33 and 34, to insert the following:
"(2) The Health Service Executive shall provide any necessary supports to any person in the making of an application under subsection 1 where, by reason of any incapacity, such person requests such assistance.".
This is a straightforward amendment which should not pose any difficulty for the Government. It proposes that all necessary assistance be provided to those who have a difficulty, including literacy difficulties, in completing forms and other aspects of applications.
I said earlier that we intend to do this on an administrative basis. However, since this provision is the same, I will accept the amendment, subject to the requirement for any drafting amendment. I will accept it if it is in order.
Amendment agreed to.
Amendments Nos. 5b to 5l, inclusive, not moved.
Question proposed: "That section 4, as amended, stand part of the Bill."
I will not delay the House unduly on this issue but I wish to register my opposition to this section, as I am doing with all the other sections. We have had a reasonable opportunity to discuss the content of section 4 in the context of the Minister's amendments and Deputy Reilly's amendment. Nevertheless, I formally oppose the section.
I am also opposed to this section.
Question put and declared carried.
NEW SECTION.
Amendments Nos. 5m and 5n are related and may be discussed together by agreement.
I move amendment No. 5m:
In page 6, before section 5, to insert the following new section:
"5.—(1) Notwithstanding any provision of this Bill, any person the subject of undue hardship or terminal illness, may apply to the Health Information and Quality Authority for a recommendation that they be issued with a discretionary medical card.
(2) The Health Service Executive shall issue a discretionary medical card to the applicant within 4 weeks of a recommendation under subsection 1 being made.".
The rationale behind this amendment is to address the situation whereby the Health Service Executive functions as both assessor and provider in the case of applications for a discretionary medical card. It is akin to being both gamekeeper and poacher. In the interests of independence, fairness and transparency, these assessments should be undertaken by an independent entity. As I have said before, I object to the introduction of means testing in respect of applications by terminally ill persons. Such individuals have done the State some service and now have six months or less to live. They should receive a medical card as of right without having to deal with red tape.
Notwithstanding that, and in view of current economic circumstances, I ask the Minister to accept my amendment so that such persons can at least be confident that their case will be assessed by an independent assessor. This does not require additional manpower because the Health Service Executive staff currently employed in this work can be transferred to the Health Information and Quality Authority where they would be at arm's length from the executive. If there are financial implications for the latter, it is possible it will take a certain view of such applications. I am not accusing anybody of wrongdoing but if somebody is undertaking an assessment the outcome of which may involve a cost for his or her organisation, there is bound to be an element of conflict. I hope the Minister will accept this amendment. I am sure she has 100% faith in HIQA, as I do.
This is a reasonable amendment. It allows HIQA to make recommendations in exceptional circumstances. It is harsh that somebody who is terminally ill and has many medical costs might not be given a medical card because the section of the HSE has consumed its budget. There should be some type of independent assessor in that situation. The Minister responded earlier today on the issue of people who are terminally ill and made the point that budgets are limited, even though there is discretion. When I was a member of a health board there were demand-led schemes. Once the demand was there, the money had to be found.
I understand that budgets are limited. However, there should be some means of separating cases of people who are terminally ill from the ordinary hardship cases, as it were. I support what Deputy Reilly is seeking to achieve in this amendment.
I cannot accept the amendment. This would be an entirely new role for the Health Information and Quality Authority. The remit of that authority is to set standards, monitor compliance with those standards and to enforce the standards. It is not to be an assessor of anything relating to the provision of services. That is not an appropriate role for the Health Information and Quality Authority.
Even if I were to accept the amendment because I believed it was a good amendment — Deputy Reilly suggests the function could just transfer over and this could be achieved with the passing of legislation — it would be a major challenge. There is currently dialogue between the two organisations and the Department on the transfer of staff in the nursing home area because we wish to introduce the regulations on nursing home standards early in the new year. We want HIQA to begin carrying out inspections during 2009 and to have the resources to do that. We are currently putting that in place but none of these developments can happen quickly.
Inspections, setting standards and reporting on adverse events, such as the report on the Rebecca O'Malley incident or the report on Ennis that is currently under way, constitute the appropriate role for the Health Information and Quality Authority. I do not believe assessing people for medical cards or for other services would be an appropriate role. That is for the organisation that has the budget for these services and has an obligation to live within that budget. The Accounting Officer, Professor Drumm, is responsible to the Committee of Public Accounts for the budget that is voted to the Health Service Executive each year by the Oireachtas.
There is nothing in this legislation to change the discretionary cards, either now or into the future. Discretionary cards are given on the basis of discretion but, as in other areas, there are budget limitations. There is a limit on the HSE budget next year; there have been budgetary limits for the health services for every year I have been a Member of this House, regardless of whether they were being run by the health boards or the HSE and regardless of which parties were in Government. There is a finite budget within which the health services must live each year, although it has increased substantially in recent years. There has been a fourfold increase in the provision by the taxpayer for public health services. That is why the transformation of how we provide the service, particularly moving to more primary and community-based care, is so important. It is more effective and we know that 95% of people's needs can be met at that level.
That brings me to the issue of eligibility for health services. We are involved in drafting major legislation, which will be controversial, surrounding eligibility for services and defining the different services to which different categories of people are entitled. It is particularly important in the context of primary care. I listened to the comments earlier about universal entitlement. There is universal entitlement to hospital services. That does not mean citizens will not take out additional insurance cover. Even if we were to move to universal entitlement for hospital services, which is a compulsory tax, that does not mean other citizens would not top up the benefits they might get.
I was previously a fan of universal health coverage, and I believe there is merit in examining how we fund our hospitals. I am particularly concerned about the level of private activity in many of our publicly-funded hospitals at the expense of public patients, who often have to be treated by the National Treatment Purchase Fund. Private patients heretofore have received preferential access. That is why the new consultant contract, which has a one-for-all access to diagnostics, changes fundamentally the way consultants work and increases the number of consultants so that people have access to services, particularly on an outpatient basis. These issues are all important in terms of access to services.
Deputy Reilly referred to two cases at the committee meeting last week. If I understood him correctly, they were persons who were terminally ill. If he will bring the personal circumstances to my attention, I will be delighted to have the cases investigated. My understanding is that discretionary cards are granted to people who are terminally ill. If I am under a misunderstanding in that, I will be happy to hear from Deputy Reilly.
In general, discretion is applied. It depends on the person who is assessing the matter but there are rules surrounding discretion. In the past, under the health boards it seemed to vary from one area to another, and the number of discretionary cards in one health board area might be substantially higher than in an adjoining health board area, even though the circumstances of the populations appeared to be similar. It is hard to understand the reason for that. With a single unified organisation there is clarity on the issue of discretionary medical cards. If the Deputy has examples of people who were terminally ill within the last six months, I would be obliged if he would make the circumstances known to me. I can talk to the HSE about the examples.
Unfortunately, I regret that one of the individuals concerned has passed on. It is too late for him. I take this opportunity to extend my sympathies to the family, whom I have no intention of naming but to whom I have spoken. Undoubtedly, there are other people who will find themselves in that situation. I know of at least one and I will consult with the Minister on it privately to preserve the privacy of the people concerned.
There has been much debate about the health service budget and how it has increased fourfold over recent years. However, it only reached the OECD average in the last two years. One cannot catch up on 15 to 20 years of neglect in terms of very low investment in health services by spending the average in two years. More will be required. However, I would not put another bob into health until waste in the sector, and particularly the HSE, is sorted out.
The Minister mentioned new consultants both here and at the committee meeting. She said there would be 189 new consultants, that 59 had been interviewed and 39 had been appointed. I do not know how many have taken up appointments or if the Minister has that information available, but can she clarify if these are new posts or replacement posts for consultants who have retired? With regard to the terminally ill, I am glad to hear the Minister's view. However, it would be better to have a policy whereby that issue would not require the Minister's direct involvement each time a hard case arose involving somebody who is terminally ill.
The Health Information and Quality Authority has shown itself to be independent and capable of doing its job. It conducted a good investigation into the situation in Limerick. I have met with representatives of the authority on a number of occasions and have no complaints about the body. However, as I have asked the Minister previously, and I regularly raise the question on the Order of Business, when will the authority be given the teeth to censure people? At present the authority can inspect a hospital and tell its management the standards are not up to what was agreed but it has no powers of censure. The hospital can say: "Thank you very much. Off you go and come back in another year." The same will happen again the next year. There is talk about licensing but that must cover public and private hospitals and nursing homes. HIQA is involved in the areas of standards and information on quality in health care. Quality information on patients is particularly relevant in assessing whether a person should receive a discretionary medical card.
I do not accept the Minister's supposition that those who hold a budget should carry out assessments because it has been proven in other jurisdictions that this approach results in peculiar anomalies. For example, in the United Kingdom the incidence of autism varies widely as between health authorities. The reason the incidence is lowest in areas where autism services are not available is that under UK law, health authorities are obliged to provide a service and pay for it from another jurisdiction. It is more than a coincidence that areas without a service record a low incidence of autism, in some cases lower than it was prior to the introduction of the relevant legislation. I do not want a similar problem to arise here.
If HIQA is not the appropriate body to carry out an assessment, and there is no reason this should be the case, why should another body not perform this function? Patients are entitled to the comfort of at least knowing they will receive an independent and fair assessment and not one predicated on the level of funds in the kitty at any given moment. In the latter case, those diagnosed with a terminal illness in January, February, March or April will receive a discretionary medical card but woe betide those who are diagnosed in September, October or November because the budget will have been expended and a discretionary card will not be granted. That is the reality. I am not arguing that this arises across the board but it appears to be the case.
I ask the Minister to reconsider her decision on the issue of assessments. I would be satisfied if she chose a body other than HIQA to perform this function, provided it is not the HSE and the approach is seen to be fair. A similar question arises with regard to the fair deal for nursing home care where it must also be decided who will assess whether patients are high or low dependency and what will be the role of those selected for this purpose in terms of their commitment to the HSE, Department of Health and Children or other body. Independent assessment is required because people must be assured they will be assessed without regard to the financial position at a given time in the year.
I agree that moving people from one job to another is not a simple task, as has been evident in the past. However, people are becoming increasingly realistic in the current climate and there is a greater willingness to try to fix what everybody regards as an appalling system in our health service.
I agree with the Minister that people could still top up if they had universal health insurance. Let them do so but let it be for five star accommodation and cordon bleu cooking rather than being allowed to jump the queue and have a colonoscopy carried out ahead of someone else. That is the issue.
On the Deputy's final point, this is precisely what we are changing by introducing a new contract. It is not acceptable to me, as a citizen and human being, that some people are given preferential access to services which are fully funded by our taxpayers, including the cost of staff. In the past ten days, a friend of mine who telephoned a public hospital to make an arrangement for a parent was asked whether the patient would be public or private. She was disgusted by this question, although the person in question had private health insurance, because she did not believe preferential treatment should be given. This approach must be brought to an end.
Universal health insurance does not address this issue if it is simply a question of paying consultants more money on top of their public salary to see other patients. The new contract——
Under universal health service, everyone has insurance and is equal in the eyes of the service.
Yes, but unless one deals with capacity issues——
That is correct.
I want the level of private activity in our public hospitals to be greatly reduced because the sole purpose of the public system is to serve the medical needs of citizens.
As to the question of which body should assess applications and so on and the conflict between being the provider of funding and the provider of the benefit, I am not aware of any health system, either publicly funded or funded through a social insurance model, which has unlimited resources.
We do not have an unlimited number of people dying of cancer.
I accept that. We must prioritise the services we provide, irrespective of whether resources are made available from general taxation or a combination of social insurance and taxation or private insurance and taxation.
It is our priority to ensure terminally ill people are provided with the highest possible quality of service. I am proud that in the mid 1990s, Ireland became the second country in Europe to introduce consultant cover for palliative care. While the system still has gaps and deficiencies, we are rapidly moving to provide appropriate services for people who are terminally ill. The cancer programme is very much about reducing the incidence of death from cancer and so on.
Regardless of how they are made, one must always bear in mind the regulatory impact of regulations. This would also be the case if Deputy Reilly or Deputy O'Sullivan were in my position. When Governments are introducing regulations, they must consider their economic impact and cost as well as wider impacts. Many worthwhile Government programmes are phased in over a medium to long-term timeframe because of the various impacts arising from making the transition from a traditional way of doing things to a new model of care. This is also the case in many areas other than health.
On standards and giving HIQA teeth, I agree that we must have a licensing regime for public and private providers. We have an authorisation regime for nursing homes and HIQA will inspect nursing homes from next year onwards when it will be in a position to close down nursing homes which do not meet standards.
What about hospitals?
We do not yet have a licensing regime. As the Deputy will be aware, the Commission on Patient Safety chaired by Dr. Madden recommended a licensing regime. We must introduce such a regime as quickly as possible. However, in advance of doing this we must know what it is we are licensing and what standards are appropriate for the acute and non-acute hospital system. As I have stated previously, health care providers generally should be licensed. We all require a licence for many things and it is not acceptable that anybody can build and open a hospital without any authorisation. I fully accept that those who work in a hospital must be registered and I am genuinely committed to and in favour of a licensing regime, which I hope to have in place as quickly as possible.
Notwithstanding the economic circumstances of recent years, as many as 70,000 people have a discretionary medical card. In November this year 196,000 people had a full medical card and approximately 85,000 people had a doctor-only card. While I accept that this figure does not constitute the largest proportion of the population to have held a medical card at any one time — I want to use the data honestly — it is the largest number of people who have held a medical card, notwithstanding the economic circumstances we have experienced.
Next year, the challenge will be to provide medical cards for more and more people who will become unemployed. We all know unemployment is rising. Since September this year, there has been a substantial increase in the number of applications for medical cards due to the economic circumstances in which we find ourselves. For all these reasons and to have the resources necessary to provide these medical cards as well as the attendant payments to doctors and drugs payments, we had to introduce legislation such as this Bill.
Ireland spends 9% of gross national income on health. GNI is the more appropriate measure because gross domestic product, which includes the multinational sector, inflates Ireland's state of well-being. Expenditure levels when measured against GDP are not as accurate as when measured against GNP. The figure of 9% of national income or GNP is ahead of the OECD average, notwithstanding the fact that Ireland has one of the youngest populations in Europe. Some 11% of the population is aged over 65 years compared to 18% in the UK, 22% in Germany and more than 20% in many other European countries. In general, countries with younger populations should be able to do better with the same level of health expenditure. However, for many reasons, we do not get the benefits of our young population. I hope some of the things we are doing such as implementing the screening programmes and placing greater emphasis on primary and community care will help to achieve better outcomes from the expenditure we are incurring. As we know, for older people, in particular, investment in measures to deal with cardiovascular disease and stroke patients are delivering significant improvements and greatly increasing life expectancy.
Amendment put.
The Committee divided: Tá, 60; Níl, 75.
Tá
- Allen, Bernard.
- Barrett, Seán.
- Behan, Joe.
- Breen, Pat.
- Bruton, Richard.
- Burke, Ulick.
- Burton, Joan.
- Carey, Joe.
- Clune, Deirdre.
- Connaughton, Paul.
- Coonan, Noel J.
- Crawford, Seymour.
- Creed, Michael.
- Creighton, Lucinda.
- Deasy, John.
- Deenihan, Jimmy.
- Doyle, Andrew.
- Durkan, Bernard J.
- English, Damien.
- Feighan, Frank.
- Ferris, Martin.
- Flanagan, Terence.
- Gilmore, Eamon.
- Hayes, Tom.
- Higgins, Michael D.
- Hogan, Phil.
- Howlin, Brendan.
- Kehoe, Paul.
- Lynch, Ciarán.
- Lynch, Kathleen.
- McEntee, Shane.
- McGrath, Finian.
- McHugh, Joe.
- McManus, Liz.
- Mitchell, Olivia.
- Morgan, Arthur.
- Neville, Dan.
- Ó Caoláin, Caoimhghín.
- O’Donnell, Kieran.
- O’Dowd, Fergus.
- O’Mahony, John.
- O’Shea, Brian.
- O’Sullivan, Jan.
- Penrose, Willie.
- Quinn, Ruairí.
- Rabbitte, Pat.
- Reilly, James.
- Ring, Michael.
- Shatter, Alan.
- Sheahan, Tom.
- Sheehan, P. J.
- Sherlock, Seán.
- Shortall, Róisín.
- Stagg, Emmet.
- Stanton, David.
- Timmins, Billy.
- Tuffy, Joanna.
- Upton, Mary.
- Varadkar, Leo.
- Wall, Jack.
Níl
- Ahern, Bertie.
- Ahern, Dermot.
- Ahern, Michael.
- Ahern, Noel.
- Andrews, Barry.
- Andrews, Chris.
- Ardagh, Seán.
- Aylward, Bobby.
- Blaney, Niall.
- Brady, Áine.
- Brady, Cyprian.
- Brady, Johnny.
- Browne, John.
- Byrne, Thomas.
- Calleary, Dara.
- Carey, Pat.
- Collins, Niall.
- Conlon, Margaret.
- Connick, Seán.
- Coughlan, Mary.
- Cregan, John.
- Cullen, Martin.
- Curran, John.
- Dempsey, Noel.
- Devins, Jimmy.
- Dooley, Timmy.
- Fahey, Frank.
- Finneran, Michael.
- Fitzpatrick, Michael.
- Flynn, Beverley.
- Gogarty, Paul.
- Grealish, Noel.
- Hanafin, Mary.
- Harney, Mary.
- Haughey, Seán.
- Hoctor, Máire.
- Kelleher, Billy.
- Kelly, Peter.
- Kenneally, Brendan.
- Kennedy, Michael.
- Kirk, Seamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lenihan, Brian.
- Lenihan, Conor.
- Lowry, Michael.
- McEllistrim, Thomas.
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- Mansergh, Martin.
- Moloney, John.
- Moynihan, Michael.
- Mulcahy, Michael.
- Nolan, M. J.
- Ó Cuív, Éamon.
- Ó Fearghaíl, Seán.
- O’Brien, Darragh.
- O’Connor, Charlie.
- O’Dea, Willie.
- O’Flynn, Noel.
- O’Hanlon, Rory.
- O’Keeffe, Batt.
- O’Keeffe, Edward.
- O’Rourke, Mary.
- O’Sullivan, Christy.
- Power, Peter.
- Power, Seán.
- Ryan, Eamon.
- Sargent, Trevor.
- Scanlon, Eamon.
- Treacy, Noel.
- Wallace, Mary.
- White, Mary Alexandra.
- Woods, Michael.
Tellers: Tá, Deputies Paul Kehoe and Emmet Stagg; Níl, Deputies Pat Carey and John Cregan.
Amendment declared lost.
As 6.30 p.m. has come and gone, I am now required to put the following question in accordance with an order of the Dáil of this day: "That the amendments set down by the Minister for Health and Children for Committee Stage and not disposed of are hereby made to the Bill, in respect of each of the sections undisposed of that the section or, as appropriate, the section, as amended, is hereby agreed to on Committee Stage, that the Title is hereby agreed to on Committee Stage, that the Bill, as amended, is accordingly reported to the House, that Report Stage is hereby completed and the Bill is hereby passed."
Question put.
The Dáil divided: Tá, 74; Níl, 62.
Tá
- Ahern, Bertie.
- Ahern, Dermot.
- Ahern, Michael.
- Ahern, Noel.
- Andrews, Barry.
- Andrews, Chris.
- Ardagh, Seán.
- Aylward, Bobby.
- Blaney, Niall.
- Brady, Áine.
- Brady, Cyprian.
- Brady, Johnny.
- Browne, John.
- Byrne, Thomas.
- Calleary, Dara.
- Carey, Pat.
- Collins, Niall.
- Conlon, Margaret.
- Connick, Seán.
- Coughlan, Mary.
- Cregan, John.
- Cullen, Martin.
- Curran, John.
- Dempsey, Noel.
- Devins, Jimmy.
- Dooley, Timmy.
- Fahey, Frank.
- Fitzpatrick, Michael.
- Flynn, Beverley.
- Gogarty, Paul.
- Grealish, Noel.
- Hanafin, Mary.
- Harney, Mary.
- Haughey, Seán.
- Hoctor, Máire.
- Kelleher, Billy.
- Kelly, Peter.
- Kenneally, Brendan.
- Kennedy, Michael.
- Kirk, Séamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lenihan, Brian.
- Lenihan, Conor.
- Lowry, Michael.
- McEllistrim, Thomas.
- McGrath, Mattie.
- McGrath, Michael.
- McGuinness, John.
- Mansergh, Martin.
- Moloney, John.
- Moynihan, Michael.
- Mulcahy, Michael.
- Nolan, M.J.
- Ó Cuív, Éamon.
- Ó Fearghaíl, Seán.
- O’Brien, Darragh.
- O’Connor, Charlie.
- O’Dea, Willie.
- O’Flynn, Noel.
- O’Hanlon, Rory.
- O’Keeffe, Batt.
- O’Keeffe, Edward.
- O’Rourke, Mary.
- O’Sullivan, Christy.
- Power, Peter.
- Power, Seán.
- Ryan, Eamon.
- Sargent, Trevor.
- Scanlon, Eamon.
- Treacy, Noel.
- Wallace, Mary.
- White, Mary Alexandra.
- Woods, Michael.
Níl
- Allen, Bernard.
- Barrett, Seán.
- Behan, Joe.
- Breen, Pat.
- Bruton, Richard.
- Burke, Ulick.
- Burton, Joan.
- Carey, Joe.
- Clune, Deirdre.
- Connaughton, Paul.
- Coonan, Noel J.
- Costello, Joe.
- Crawford, Seymour.
- Creed, Michael.
- Creighton, Lucinda.
- Deasy, John.
- Deenihan, Jimmy.
- Doyle, Andrew.
- Durkan, Bernard J.
- English, Damien.
- Feighan, Frank.
- Ferris, Martin.
- Flanagan, Terence.
- Gilmore, Eamon.
- Hayes, Tom.
- Higgins, Michael D.
- Hogan, Phil.
- Howlin, Brendan.
- Kehoe, Paul.
- Lynch, Ciarán.
- Lynch, Kathleen.
- McEntee, Shane.
- McGrath, Finian.
- McHugh, Joe.
- McManus, Liz.
- Mitchell, Olivia.
- Morgan, Arthur.
- Neville, Dan.
- Ó Caoláin, Caoimhghín.
- Ó Snodaigh, Aengus.
- O’Donnell, Kieran.
- O’Dowd, Fergus.
- O’Mahony, John.
- O’Shea, Brian.
- O’Sullivan, Jan.
- Penrose, Willie.
- Quinn, Ruairí.
- Rabbitte, Pat.
- Reilly, James.
- Ring, Michael.
- Shatter, Alan.
- Sheahan, Tom.
- Sheehan, P.J.
- Sherlock, Seán.
- Shortall, Róisín.
- Stagg, Emmet.
- Stanton, David.
- Timmins, Billy.
- Tuffy, Joanna.
- Upton, Mary.
- Varadkar, Leo.
- Wall, Jack.
Tellers: Tá, Deputies Pat Carey and John Cregan; Níl, Deputies Paul Kehoe and Emmet Stagg.
Question declared carried.
A Cheann Comhairle——
(Interruptions).
As Deputy Kehoe is a Whip, he is entitled to speak at this point.
I warn the Deputies opposite to watch themselves on their way home as people over the age of 70 will be out to get them.
The Bill will now be sent to the Seanad.