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Dáil Éireann debate -
Thursday, 21 Mar 2013

Vol. 797 No. 2

Health (Alteration of Criteria for Eligibility) Bill 2013: Second Stage (Resumed)

Question again proposed: "That the Bill be now read a Second Time."

As I said previously, it is very regrettable that alterations have to be made to the eligibility criteria for medical cards for people over 70. However, the other side of that coin is the fact that more people will have medical cards and GP-visit cards at the end of this year than currently hold them because more people are coming into the marketplace all of the time and provision must be made for them.

I have been consistent in recent years in trying to ensure that the Department of Health monitors its expenditure on a monthly, if not weekly, basis to try to ensure that major cuts do not have to be made at the end of the year because spending was not monitored properly. The Minister and Minister of State are correct in doing that, even though this decision is difficult.

I am not trying to make a political point when I say that I am saddened that former Government Deputies who are now in opposition accept no responsibility whatsoever for the situation now affecting the nation. Deputy Finian McGrath may laugh at that and think it is funny.

I do not think it is funny.

The people in this country must recognise that there are no easy options. The country continues to be in a precarious situation. At the best of times, it was a difficult situation while at the worst of times, we could have fallen over the cliff. We are very lucky to have political parties in this country that were prepared to take responsibility for running the country at this difficult time. On taking office, this Government inherited all of the bills, both private and public but both parties in Government accepted the challenge. In other European countries, parties offering for Government in a similar climate have failed and continue to fail.

As I pointed out last night, there has not been a single indication from anybody on the other side of this House that he or she intends to do anything other than spend the public's money. The Opposition wants to spend money that the public will eventually be accountable for, in terms of repayments. It wants to spend money that does not exist even though this country is €1.2 billion short of meeting its commitments every month. That is a stark and startling situation and in that context, I hope that there will be a recognition by the Opposition that the situation in which we find ourselves must be remedied. It cannot be remedied by people who were in control at the time and who now wish to run away from reality. Simply because certain Deputies happen to be in County Meath engaged in a by-election campaign does not relieve them in any way of responsibility for what they entered into when they were in control.

Sadly, people's feelings are being manipulated in a cynical fashion at the present time. People are being treated as if they are children and that is not fair. It is not fair to the people, to political parties and to Independent Deputies. Everyone must recognise that we are in a difficult and tight spot. This Government does not take any pleasure in doing what has to be done. It grieves Ministers and the Government as a whole greatly to have to do some of the things we are doing.

There is no point in trying to say that European institutions did this to us because they did not. We did it to ourselves, individually and collectively. People can seek someone to blame but we must all take some responsibility. To take that point to its logical conclusion, why not challenge and charge people for malfeasance under various Acts? Why not bring people to court, charge them and see what happens then? However, as we know from experience, very few people want to accept responsibility for their activities in the past. There have been many investigations in this House, the DIRT inquiry being a prime example, but very few people have been willing to accept responsibility for their actions in the past. That is the way it has been and continues to be.

It is with great regret that the Government finds it necessary to review the entitlement to a medical card for those over 70, even though the decision to grant medical cards to such people was made in the run-up to a general election, in order to buy the votes of older people. That decision was made with the approval of many Deputies who are now on the other side of the House. That is the reality and unfortunately, avoiding reality is something we have been particularly good at in recent years. This Government recognises that the decision now being taken will create difficulties. It will create difficulties for Ministers, backbenchers and members of the public. It will create difficulties for families, for those at work and those unemployed, as well as those who are retired.

Sadly, there are very few options available to us and none is easy. When people pretend to insist that there are easier options available, they are wrong and they continue to damage public confidence in the institutions of the State.

I have been a couple of years in this House and I have seen it all before. History has indicated that succeeding generations seldom learn from the mistakes of their predecessors. We have only to consider what happened in Europe in the 1920s and subsequently to see this, and the same arguments are taking place now that took place then. These are arguments about who is to blame and how we can get even. This usually ends with people getting even only with themselves, which is tragic.

It goes without saying that Ministers are doing everything possible to alleviate the burden on the people affected by this and other measures. This comes as no surprise and many of us anticipated this problem two, three, four or five years ago. Many of us predicted everything that happened. We must ask the question of whether we can afford a repetition of the kind of scene we have or have had for the past number of years, with the people led to the top of the hill and shown the vista before them as the promised land. Suddenly, hopes were dashed and people found themselves between a rock and a hard place. It is truly appalling.

This is not a political point but rather a lesson for everybody who enters this House from now on. If there ever was a lesson to be learned, it should come from the indiscretions of the past 15 years, when it was quite clear the economy was going well and could fend for itself. Greed took over, everything was thrown by the wayside and the idea was for everybody to have a party. Unfortunately, we are now paying for that in spades.

I hope people will understand this measure and if they do not, there will be a worse problem that must be dealt with in a different way at a different time. To those who say we do not know what we are talking about, that idea cuts both ways.

I am thankful for the opportunity to speak to this new legislation, the Health (Alteration of Criteria for Eligibility) Bill 2013. The medical card issue and the health of our senior citizens is important and should be part of a broader debate on health service efficiency and proper care for those over 70. We allow senior citizens a great debt, particularly those who paid taxes through their noses in the 1970s and 1980s. I remember very well the famous PAYE marches from years ago, and these people paid taxes and made a contribution to the State. They deserve care and respect for that work. We discovered later that many people from that time did not pay taxes, and I welcome the fact that the Revenue Commissioners have brought in more money because of efficiencies.

Overall, nearly 43% of the national population has free access to GP services under the General Medical Services scheme. As 1 February 2013, there are 1,855,797 medical cards, equating to over 40% of the national population. There are 130,301 GP visit cards, representing nearly 3% of the population. Expected activity in 2013 for medical cards and GP visit cards reflects the Government's approach to the issue, with the total number of medical cards expected at the end of 2013 at 1.921 million and the total number of GP visit cards expected to be 265,257 at the end of 2013. This is the scale of people affected by the medical card eligibility rules.

In the 2013 budget, two interrelated changes to the over 70s medical card eligibility arrangements were announced. The income limit for an over 70s medical card is to be reduced to €600 per week, or approximately €31,000 per year for a single person, and €1,200 per week, equivalent to gross income of about €62,000 per year, for a couple. For those whose income is between €600 and €700 for single people and between €1,200 and €1,400 for couples, they will receive GP visit cards. They will also continue to have the cost of their GP services covered, with the HSE meeting the prescription drug costs in excess of the drugs payment scheme threshold of €144 per month. There are approximately 370,000 people over 70 in the State, with approximately 360,000 medical cards issued to people over 70, leaving coverage of that population at approximately 97%. I welcome that. The medical card coverage for those under 70 is approximately 35%. The policy change will leave approximately 92% of those over 70 unaffected, with approximately 20,000 medical card holders over 70 - the wealthiest 5% - continuing to receive free GP services instead of the medical card.

I listened very carefully to Deputy Durkan's points. I do not know if he was listening to the previous debate on disabilities but a number a of Independent Deputies have always dealt in reality and put forward positive proposals. Our proposal for the mobility allowance issue was in the region of €12.6 million. People are angry because this Government broke promises when it was elected. We knew of the crisis at that time, and when I was banging on doors, I remember being told that people should try to do their best in here. Nevertheless, people did not want to listen to false promises, which is why many people are grieving so greatly, as Deputy Durkan indicated.

The Deputy stated that we all caused the problem, but certain people - including some politicians, Ministers, developers and senior bankers - caused it. We must not label everybody when we are apportioning blame for the economic downturn and the crisis. Some people were greedy, cocked up and did not do their job efficiently, and they should get the blame. I endorse Deputy Durkan's comments to the effect that some of those people who wrecked the country should be charged. I do not wish to interfere with the judicial system but I hope to see some prosecutions in the end.

A transitional arrangement will apply to current medical card holders over 70. Those who qualified for medical cards before 1 April 2013 will automatically retain those cards until 31 May 2013. Between 1 April and 31 May 2013, medical card holders over 70 who qualify for a GP visit card - where gross income is more than €600 but less than €700 for single persons or more than €1,200 but less than €1,400 for couples - will be required to notify the HSE accordingly. Under the legislation it is proposed to make a change in the manner in which those over 70 who have obtained judicial separation are assessed. With the proposals, separated people over 70, although still legally married, will be assessed as single persons, which is welcome. Their assessment will take into account obligatory maintenance payments.

This proposed approach is similar to that used by State bodies such as the Revenue Commissions. These are the details in the legislation.

Going back to the higher GP usage by older people, there are some interesting statistics. Older people use the health services more often than young people. The CSO survey shows that in 2009-10, older people were more likely than the general population to visit their doctor in that year; 74% of the general population visited a GP at least once in a year while 94% of those over 70 visited a GP at least once a year. The same study shows the average number of GP consultations increases with age, with 18 to 24 year olds averaging 2.4 visits per year and the figure rising to 5.4 consultations per year for those 70 and over.

I know the Minister of State is interested in the broader debate and his heart is in the right place. We must look at a sensible, fair and equitable health service for the entire population, with sensible funding proposals based on the general taxation system. I strongly advocate universal health services similar to those in other countries. I would pick the models that are most efficient and work best to emulate. Currently, many people covered in the private health insurance sector face huge costs. I know many people who would rather give few bob extra in tax so they did not have to go to private companies for health needs. The Government has a fair and equitable health service on its agenda and if it comes up with the right proposals, many people on the Opposition benches will support them. Health must be prioritised but it is about more than just spend, spend, spend, as Deputy Durkan pointed out. There must be clear funding and stability, along with efficiency.

I have seen some tremendous examples of good practice in the disability sector in the last six months. The sector has taken a financial hit while continuing to deliver quality services, particularly those working in the intellectual disability sector. Fresh, new people are working in the sector, young adults between 20 and 35 who are working with those with intellectual disabilities. They are doing amazing work and it is important we mention that in this debate. Just because they are examples of good practice does not mean we must penalise them by cutting their budgets. We should reward them instead. The 500 respite and residential care places per year for four years between 2012 and 2016 recommended by service providers can be achieved and would make a major dent in this issue.

The new income limits for medical card eligibility for persons over 70 were announced in the budget for 2013 and this Bill introduces that change. It is anticipated the measure will generate €12 million in savings during the second half of 2013 and €24 million in the full year. We all know this is a difficult time for the Government and the Department of Health. This saving is part of the €781 million in savings the budget set out to achieve in health spending, including an overall reduction in the cost of primary care schemes of €323 million. That is the bigger picture but I urge the Ministers that while looking at waste and efficiency, they must also be conscious that front line services or services to senior citizens or those with a disability must be given special exemptions from any cuts. The vision of the health service can be observed through how it treats the weakest and most vulnerable.

That €781 million in savings in 2013 must not be achieved by slashing and burning. There are many examples of good practice in the health service. There are problems in certain areas but we should reward and develop good practice and efficiency. I commend the staff working in the health services, the doctors, nurses, carers and porters, who all do an excellent job.

The new income limits are that a single person over 70 with a gross income of €600 per week will qualify for a medical card, while a single person over 70 with a gross income of between €600 and €700 will qualify for a GP visit card. We should encourage preventative measures for senior citizens. We have many good senior citizen groups and we should encourage them to be more proactive in encouraging physical exercise for older people. This would reduce the need for many GP visits and visits to accident and emergency departments.

I was recently in the accident and emergency department of Beaumont Hospital with a minor complaint. I was on a chair for 17 hours, then I got an armchair before eventually getting a trolley. While there, I met many senior citizens and it was very upsetting to see how they had to wait. The Minister of State should keep fighting on this, we must do something about it. It is easy to score political points but the bottom line is that anyone who has the chance to be in government for five years must make some sort of impact.

The purpose of the Bill is to amend the Health Act 1970, as amended, to change the eligibility rules for medical cards for persons aged 70 years and over. The date the changes come into effect will be by order made by the Minister. Section 7(4) makes provision for the HSE to provide support to anyone who seeks help in making an application due to any incapacity. That is a good section because, as most back bench Deputies know, there are many problems for senior citizens and those with a disability when dealing with bureaucracy and HSE application forms. Many of them come to our clinics, which is part of our job. I hope section 7(4) is implemented in a professional and caring manner. Section 7(10) defines the meaning of "civil partner" as that in the Civil Partnership and Certain Rights and Obligations of Cohabitants Act 2010. This is a progressive subsection that acknowledges the reality of modern Ireland.

I welcome the debate on this legislation. I urge the Minister of State to introduce radical new reforms in the health service. If we are to help the over 70s we must tackle the other problems and get involved in health promotion campaigns. There is a great deal of potential to make sensible savings without directly affecting senior citizens.

This Bill sets out to achieve savings of €24 million annually. It is envisaged that €12 million will be saved in the second half of this year if the Bill is passed. The overall budget for the medical card system is €750 million. The €24 million being saved is nitpicking in the overall context. Statistics show older people make more use of their medical cards than the general population. The figures show 94% of people over 70 visit their GP on a regular basis. It follows then that they have a high intake of drugs to help them cope with illness and disability.

As highlighted recently, the savings can be trebled or quadrupled if the whole issue of the cost of drugs is tackled. I appreciate that efforts have been made by the Minister for Health, the Taoiseach and the Minister of State, Deputy Alex White, in this regard. The issue must be tackled vigorously. We learned recently from the Sunday Business Post that vital drugs and medicines here cost double and treble the amount at which they are available to the National Health Service in the UK. We cannot allow this to continue where a neighbouring island only a short distance away uses the same suppliers. That is a ridiculous comparison. This is the route we should take. If we go in headlong, it is obvious that such costs are a deterrent to those seeking medical aid. Although covered for the cost of the doctor's visit, the next stop is the pharmacy. There are also the costs at the accident and emergency units which will be imposed and hospital daily care charges will be lost to this group, which is a vulnerable sector of society.

The gross income limits will be reviewed annually by the Minister for Health. The Bills Digest states that the limits may be increased or decreased with the consent of the Minister for Public Expenditure and Reform. This will deprive more than 5% of the people of the medical card if the Bill is passed. That review should be done in a sensitive manner. We should not be too aggressive with these people. It has been stated that the transition period will continue up to May but perhaps the Minister would consider extending it to the end of summer as many people will have to face various forms and online communications with which they are unable to keep up.

A whole raft of overheads is coming on stream for these people - the local property tax, domestic water charges in addition to a cut in the telephone allowance and a cut in household benefits such as electricity and gas. There is the imposition of the 1% levy on hard-earned pension pots which had been put aside for a nest egg. There is also the accessing of health insurance and all types of insurance, including motor insurance. I ask the Minister to row back and rethink the issue. I am not in favour of this in the current situation.

The new arrangements provided for in budget 2013 to address Government spending for medical card schemes could be viewed as an important marker for how we distribute scarce resources in a fairer and more equitable fashion. It is clear that a balance must be struck between protecting the most vulnerable members of society while also being mindful that those who can afford to carry more of the costs of their treatment should do so in the fairest way possible. Fairness is the key word when evaluating the changes to qualifying criteria for medical cards for older members of society. The proposed changes in the Bill will have absolutely no effect on the vast majority of older citizens. They will affect only the relatively better off, those who have single income in excess of €31,000 or couples with incomes in excess of €62,000.

There is an ongoing and very necessary debate about what people consider fair and how middle income individuals, those who are at work paying mortgages and educating children, consider they have shouldered the brunt of rebuilding the nation's economy. It is clear that only the most well-off individuals will be affected by the particular set of changes proposed in the legislation. Those over 70 who, by any objective measurement, have the capacity to pay more towards the cost of medical treatment will pay more. This is a position I support. Nine out of ten over 70s will not be affected at all by the change and will still receive a full medical card. Of course, those who fall below the limit, down as far as €600 per week or €1,200 for a couple, will still receive free GP cards, allowing them to visit a doctor as and when required. It is important to note that those few affected by the change will not, as Deputy McGrath and others have pointed out, have to give up their cards immediately as there will be a transitional arrangement in place. Those who qualified up to April 2013 can hold on to their cards until the end of May.

In targeting the scarce resources towards those who arguably need them the most, tough decisions are required. These decisions need to be fair and to be seen to be fair. In many ways the decision in the first place by the Fianna Fáil-led Government to award medical cards to everyone over 70 years of age, regardless of income and resources, epitomised the political and financial culture that pertained and which bankrupted the country. That decision did not make financial sense, and neither did it pass the test of equity. The economic crisis which we are pulling out of was a direct result of a succession of vote-grabbing flourishing of bust cheques from successive Fianna Fáil Governments based on what we now know was an utterly false developer-led boom and nobody should forget that. The adjustments to this scheme, reflected in the Bill, are necessary and they are required to ensure that the money we have available to us goes towards funding schemes of critical importance for those who need the most. I support the legislation.

Deputy Gerard Nash should have indicated at the outset that he was sharing time. The remaining speakers in this slot are Deputy Tom Hayes for five minutes and Deputy Regina Doherty for ten minutes.

I am delighted to have the opportunity to speak on the Bill. When ever spending reductions or cutback are proposed, it is always difficult for people. This Bill is no different. The fact is we are living in difficult times. This is obvious in every sector of society. No matter what sector one speaks with, everyone appears to have problems, particularly in running their homes or business and we, in running the country, have a difficulty as our finances indicate and we must do the best we can for the people. That means we must have sensible and good services for the people, whether in health services, education, transport or agriculture, and it is hard to do that in difficult times. The proposed cutback in medical cards is a sensitive issue and has to be seen to be fair. Therein lies the challenge. There are many areas I wish to highlight and bring to the attention of the Government, the Minister and the Minister of State, Deputy Alex White, who is present. There are many sections of society who should not lose the medical card, for example, women with cancer. In my constituency I meet people suffering from cancer. I do not have to tell anybody in the House of the trauma people go through when families, particularly a mother, are hit by cancer. I have witnessed situations in my constituency where people, whether in the public or private sector or the self-employed, have to undergo a means test and an assessment.

I speak in particular about the self-employed, people who are trying their best to keep a business going who might be struck down by an illness such as cancer. When they apply for a medical card they cannot get it. In this day and age when we can give a lot out for nothing and we try to look after people, it is desperate that those people are left without a medical card. I have raised the matter previously, but nothing seems to change. I request that in future assessments of the medical card situation the Minister for Health should look at those vulnerable people. It is unfair on them at a hard time in their lives.

I understand the Government needs to find areas in which to make savings, but savings could be made in other areas. Some of the earlier speakers talked about the drug purchase scheme, which leaves much to be desired. There needs to be more consultation with the people working in the health service. Every week in my clinics and elsewhere, I come across people who work in the health service. They point out several opportunities to cut out wastage. We need more consultation with the people working on the front line. When they come to our clinics protesting about what we are doing, they say they could find savings but have not been consulted. In future the Minister should try to consult more with the people and he will find great knowledge and ideas for savings without having to touch the areas that affect people. We were all elected to public life to try to help people. Medical cards provide great security for people. In future, we should consider other ways to make those savings and avoid impacting the most vulnerable in our society.

One of the key priorities of the Department of Health, the HSE and Department of Public Expenditure and Reform has been to make savings in the health budget through measures that are concentrated, implementable and durable. There has been significant progress against the backdrop of extraordinary cuts. The Minister, Deputy Reilly, has said that his principal stand is not to cut services, but to cut the cost of those services. In 2010, the cost of operating the GMS for 1.7 million users was €1.9 billion. The specific cost of the over 70s medical card scheme is €750 million per annum. It is forecast that the measure in this Bill will generate €12 million in savings during the second half of 2013, and €24 million in a full year. This saving is part of the €781 million in savings that budget for 2013 set out to achieve in the health budget, to include an overall reduction in the cost of primary care schemes of €323 million. The Government's primary aim is to cut the cost of services and not the services themselves.

I challenge the scaremongers, who mostly exist on the Opposition benches. Let us remember that 92% of people over the age of 70 will retain their medical card. The Government's commitment to protect the most vulnerable remains more steadfast than ever. The maintenance of health services will be a key priority next year despite the need for significant savings.

A significant part of this Bill allows for data sharing between the HSE and the Department of Social Protection, and the HSE and the Revenue Commissioners. This will include the sharing of personal and sometimes sensitive data between these bodies for purposes of assessing and reviewing eligibility, entitlements and liability for taxes and charges. The Data Protection Commissioner must be consulted before such data can be shared. We have repeatedly been given the hoary excuse that the computer systems of the Revenue Commissioners and Department of Social Protection were not up to scratch and communications between those two statutory bodies were impossible. If this problem has been known about for so long, why was it not tackled and sorted out years ago? It will certainly be tackled now.

Instead of engaging in across-the-board cuts the Government is taking a measured approach as outlined in the Bill. It is vital that any possible changes are made in a manner that takes full account of those most in need. Having worked all their lives, the least we can do for the older community is to ensure that they can live out their years with decency, and without having to scrimp and save every penny.

The changes proposed in this Bill are happening in the context of broader health service reforms which will create a single-tier health system, where the need of the patient is put at the centre of the health system. These include the phased introduction of free GP care for all and the introduction of universal health insurance, which will effectively end the two-tier health service.

The reforms are working. Not alone have we proven that we can maintain a safe service, despite the naysayers, we have actually improved services in the past two years. There has been a reduction in the numbers of people on trolleys and a reduction in waiting times for elective procedures. Figures published last November showed that the number of adult patients waiting longer than six months for an elective surgical or medical procedure had fallen by 37% since the Government took office. The number of children waiting longer than three months for a planned procedure had fallen by 66%. The recent response to a parliamentary question also showed there have been far fewer operations cancelled during the Minister's tenure than during the tenures of his immediate predecessors, who had plenty of time and money to address the health services.

Eight years ago, the HSE was established in response to the excessive spending and certain difficulties within the regional health boards. It became a catch-all, obese organisation, independent and over-staffed, presiding over a succession of health scandals. The measures detailed in the recently published Future Health - A Strategic Framework for Reform of the Health Services 2012-2015 are very different. The actions are now specific and time-bound. The Government is confident to be held to account. The goal of all these reforms is to put the needs of the patient at the centre of the health system. The essential public nature of the health system will not be changed. We will see a new focus on keeping people healthy while moving away from simply treating ill people.

The Government is conscious of the importance of health and health care to all members of our society, particularly during a time of economic crisis. We will move away from the current hospital-centred model of care towards a new model of integrated care that treats patients at the lowest level of complexity that is safe, timely, efficient and as close to home as possible. Structural reform is key to addressing the problems of the health service according to the document, which emphasises the need for good governance, the avoidance of duplication and a strong regional focus in delivering value for money.

The complexity of the health care environment necessitates that health policy, legislative objectives, resource allocation models and management structures be aligned to plan and deliver health care services strategically. Health care systems around the world struggle to reconcile three competing objectives: equality of access, high quality and low cost. These are objectives which the Minister, Deputy Reilly, has made the cornerstones of his reform programme.

The Government's health strategy focuses on the key aims of the integration of health and social care services to better meet the needs of the population of Ireland. This integration of service delivery across professional and institutional boundaries will deliver health care based on client needs and in the most cost-effective location. Ensuring that patients are able to move easily through the entire care system requires services that are well organised and informed by best available evidence and practice. In this context, there is an emphasis on the provision of a model of integrated care that leads to greater integration between primary and secondary care with the development of care pathways, referral protocol, guidelines and shared-care arrangements. Using performance data and other available information will help to determine performance and improve services based on the needs of patients. Nobody ever said it would be easy but it is going a long way with the reforms started by the Government.

The document is highly significant in that it will affect our well-being and economic social performance like no other initiative. In addition to the aspects already mentioned - universal health insurance and free GP care - I wish to highlight the new patient safety agency to be established and also the health and well-being agency.

This shows the holistic approach the Government is taking towards the delivery of services, particularly its proactive rather than reactive measures in the area of health and well-being.

The value for money report and access to care variations are key components of the implementation of any process and need to be closely aligned to the strategies outlined in that document. The focus now is on keeping people healthy rather than treating them when ill. It is also proposed to move from the hospital centre model of care to a new integrated service which treats patients as close as possible to home while ensuring the best possible value for money for the State.

This Bill is only one small step towards the delivery of the €700 million savings required this year in the health services. However, it is a measured and effective cost-saving exercise. I commend the Bill to the House.

I thank the Technical Group for sharing its time and allowing me to speak on this Bill. This legislation provides us with an opportunity to discuss generally the administration of medical cards and what has been happening in this regard over the past 24 months in particular. Owing to the downturn in the economy, people who never before envisaged needing a medical card have found themselves reliant upon having one. Medical cards for the over 70s are vital given the raft of additional charges they now have to pay. While some of these people have paid off their mortgages, many are living on modest pensions from which they must meet the cost of the household and water charges and fuel costs, which have increased dramatically over the past three years. The average home heating oil bill has increased by 60% to 75% over the past three years, which is an enormous increase in terms of the income on which people on modest pensions are living.

I do not like speaking about a person who has left the House. However, I cannot tie anyone to the Chamber. Deputy Nash referred in his contribution to people on this side of the House being engaged in vote grabbing. It is a little rich for a member of the Labour Party to be speaking about vote grabbing given the signed pledges broken by that party on taking up office. Yesterday and today, there were protests outside this House by people who believed the promises made to them by the Labour Party and Fine Gael. While I am critical of the contribution made by Deputy Nash, I welcome the positive and sincere contribution made by Deputy Tom Hayes in regard to people suffering from cancer. The Minister of State, Deputy White, has been involved in politics for a long time and may recall that in the past a person with a consultant diagnosis of cancer was, regardless of means, entitled to a medical card, which was right and proper. A person who has cancer has enough to deal with and should not have to be concerned with the cost of medical care. I would like a return to the situation of the past whereby a person diagnosed with any form of cancer, regardless of means, was automatically entitled to a medical card. This should be reintroduced and should continue.

During a briefing two weeks ago I discussed with officials from the Department, who deal with applications for carer's and disability allowances, invalidity pensions, illness benefit and so on, the issue of eligibility in general for medical cards. When it comes to assessment of people under any scheme, the goalposts have been moved dramatically, in particular over the past three years. Previously, applications for a medical card accompanied by a general practitioner's report on a person's illness, be it cancer or another illness, was sufficient. Currently, people are being refused a medical card on the basis that their medical evidence is not sufficient. What this means - the officials will not put this in writing; they never do - is that the evidence required should be from a consultant rather than general practitioner. I tried hard to drive home that point with the officials during the briefing two weeks ago. Every politician, including the Acting Chairman, Deputy McConalogue, will be aware that medical evidence from general practitioners is not now being accepted. An application supported by anything other than a consultant's report will be refused. That is a fact. I challenge anybody to tell me or prove that I am wrong in that regard.

It is particularly mean that Department officials, when following up on applications for medical cards or under any other scheme, are requesting that the person provide more evidence from their doctor. People are taking this to mean that they require stronger evidence from their doctor. While the doctor has given the best medical evidence available, he or she is not a consultant. The officials need to be straight with the people and tell them that they will not qualify for a medical card or illness benefit without evidence of diagnosis from a consultant. While in the first instance I would rather that the doctor's evidence be sufficient, if that cannot be accepted, the officials should tell the people the truth. The Minister of State will be aware that this process is resulting in additional financial burden for people. While in many cases consultants do not charge for updated reports, a consultant who has not seen a patient for a period will be unable to provide an updated report without first seeing him or her, which incurs a considerable cost. Consultants must and do charge, which puts a further financial burden on people.

The gist of this legislation is amendment of the eligibility rules in respect of the over 70s medical card. As stated, under the GMS scheme, almost 43% of the national population has free access to general practitioner services. I am concerned that given the number of people who have GP only cards and do not have the financial wherewithal to take care of their health, what is proposed in this Bill will result in more cost to the State. I would not like to see a situation whereby people will opt to wait to see if they get better rather than go to the doctor. If this happens, they may end up critically or dangerously ill and need to be hospitalised.

We all know what happens when people are hospitalised; they take up acute beds which incurs considerable expense. The earlier people are assisted, the better, and if having a medical card entices them to go to their local GP in time, it is sensible, prudent and the right way to go. Since 1 February 2013, some 1.8 million medical cards are in circulation, which equates to 40% of the national population. This reflects what I stated earlier, that people are under a financial pressure they never were before.

I appreciate that the reduction in income limits is being introduced to reduce spending on medical cards for those aged over 70, and it is forecast this measure will generate €12 million in savings during the second half of 2013 and €24 million in a full year. This sounds like an almighty amount of money, but if it results in people taking up acute beds when they should not be, we might spend a lot more. We must be very careful that we do not throw out the baby with the bath water.

The changes proposed in the Bill are in the context of broader health service reforms. These include the phased introduction of free GP care for all and the introduction of a universal health insurance plan for 2016 which will effectively end the two-tier health service we have at present. On a daily basis people are dropping their VHI or full health cover because they cannot afford it. A headline in one of the national newspapers today states people in negotiations with banks on debts and mortgages in crisis will be told to get rid of a car or private health insurance. This is not sensible because it is awful to think of anyone with private health insurance not being able to pay for it and having no proper medical cover. This is not right and it is not a good way for people to finish up. It is certainly not a good way for those aged over 70 to finish up.

The Bill being published so close to being initiated in the Oireachtas means stakeholders and interested people have had little opportunity to make statements. I want to highlight the views of Age Action Ireland, a group about which I know a considerable amount and I support the work it does. Following the budget announcement in December 2012, Age Action Ireland criticised the reduction in income limits for those aged over 70. It stated the sharp reduction in the income threshold for medical cards for those aged over 70 will cause hardship and further undermine the ability of older people who will lose their cards as a result to meet their health care costs. Age Action Ireland was also concerned about this reduction in the context of a number of other charges facing older people, as I already stated, as a result of budget 2013, such as the increase in the prescription charge for medical card holders from 50 cent to €1.50, the increase in the threshold for the drug payment scheme, the decrease in the amount available for the household benefit package, the introduction of a carbon tax on solid fuel and the introduction of a property tax. This is a major issue and I ask the Minister of State to take on board the views of an association such as Age Action Ireland because it does invaluable work in representing elderly people.

Nobody should ever underestimate the importance or value of heat when it comes to elderly couples and people aged over 70. There is nothing worse than visiting an elderly person - not that I would consider a person over 70 to be elderly now because thankfully people live longer than they did in the past - and finding the person in a room without adequate heat. It is most distressing. This in turn leads to bad health. Today is a cold day and many people in the city, and in towns, villages and the rural countryside, do not have adequate heat in their houses. I feel tremendously bad about this. The Government should address this in a more concise and workmanlike way. An elderly person not having heat automatically leads to medical problems. The simplest cold can progress to a flu and then to pneumonia which, in a very short time, could kill a person. This is happening on an hourly basis.

I am sure of my facts because I know of many instances of elderly people who stay at home and do not have adequate heat to keep them warm during the day or at night. This is a crisis which should be tackled. The introduction of a carbon tax on solid fuel was a horribly mean measure. It was also mean to young families. The country must ensure older people are warm in their homes at night, otherwise it will have a knock-on effect on their health, and it is an awful thing to do to these people who have worked so hard all their lives. It is awful to think they find themselves in a position of not being warm when they sit down and take their ease, which they are perfectly entitled to do after a lifetime of work and perhaps rearing families. I would like to hear the comments of the Minister of State on this.

When it comes to processing medical cards, one of the biggest debacles we have witnessed in the history of the State was when people thought it was a good idea to take the processing of medical cards away from county level. We had a great system whereby those processing medical cards worked in conjunction with community welfare officers and knew everybody. A network was in place. Local and national public representatives were able to make direct representations to those dealing with the processing of cards. Additional information may have been required and it could be streamlined or handed in. It was a great system. People thought the right thing to do was break up this system. The excellent local knowledge has been taken away. Local community welfare officers no longer have direct input to impart their knowledge to those processing cards. This was a shocking thing to do. We have all seen the disaster which ensued. People are waiting for their medical card applications to be processed which in turn means people are not able to take care of their health needs or avail of other benefits which go along with having a medical card, such as sending young lads to school. The extraordinary waiting period has deprived people of medical cards. It was an extremely poor decision. I have spoken to many people involved in the old system, such as community welfare officers or those dealing with the cards, and they all say it was a shameful thing to do which certainly did not benefit those applying for medical cards. The same happened with regard to student grants but I do not want to speak about this because I want to stick to the subject at hand.

I am opposed to changing the criteria for medical cards for those aged over 70.

Nowadays, people find it hard enough to qualify for a medical card or a GP visit only card, be they over 70 or not. This is a penny wise and pound foolish endeavour. The Minister of State may claim that we are going to save €24 million but I do not think we will save one cent. I remain to be convinced otherwise. In the longer term, I think it will actually cost the State money.

Local GPs, who work with their patients daily, were previously able to contact the local processing centres when a medical card was applied for. They could thus have an input but all of that has virtually gone now. That personal connectivity has gone to Dublin where everything else has gone also. There are so many Government Ministers and Deputies in or around the capital that they think the whole world stops at the Red Cow roundabout and we do not exist at all. This is one of the most anti-rural governments we have had since the foundation of the State and that will be proven in time. The Government is anti-rural; it is all about centralisation and grabbing everything for Dublin but time will prove this policy to be wrong.

I thank the Acting Chairman for his indulgence. I also thank the Technical Group for the time its Members have afforded me. I am grateful for the opportunity to contribute to this debate.

This Bill seeks to amend the eligibility rules for the over-70s medical card. Some 40% of the population has free access to GP services under the GMS scheme. As of 1 February, there were 1,855,797 medical cards, which equates to 40% of the population. In addition, there are 130,000 GP visit cards, representing nearly 3% of the population.

Medical cards were providing blanket cover to the over-70s, of which there are 370,000 in the State. Currently, some 360,000 medical cards have been issued to people over 70, providing cover to about 97% of that cohort. About 35% of the population aged under 70 is covered by medical cards.

The policy change will leave about 92% of existing over-70s as medical card holders. About 20,000 over-70 medical card holders - that is, the wealthiest 5% - will continue to receive free GP care instead of a medical card.

Over the past two years, the Government has undertaken a stock-taking exercise of extravagances. The over-70s medical card should not be seen as an extravagance but we have had no cross checks between social welfare, Revenue and the Department of Health. Many concerned people are ringing me because they are being asked about their medical cards and whether they require them. The vast majority of elderly people have no need to worry because we are effectively undertaking a stocktaking exercise. However, there are people with medical cards who should not have them. I am not talking about the over-70s, but well-connected people. The knew somebody who knew somebody else but I cannot understand why they got medical cards.

I wish to praise the Department of Health, the Department of Social Protection and other Departments that are now writing to people on this matter. A "nod and wink" system went on but people are now handing in their medical cards, which I welcome. However, we should do everything possible to ensure the elderly, especially the over-70s, have medical cards, free GP visits and access to the health services they require.

I am a VHI member and pay for my own cover and that of my mother who is over 70. There are many people around the country who may not go to a doctor because it will cost €40 or €50 and they may not be able to claim it back. I am delighted that people have medical cards enabling them to visit the doctor and get their drugs. There is another side to the story, however, where taxpayers must think twice before visiting a doctor or getting prescriptions due to the cost involved. Such people do not have the required money because they are paying for mortgages, light, heat and phones. There is a big debate going on but I know the Government is committed to ensuring that people who deserve to have a medical card, need one and will not abuse it, will have one.

The cost of private health insurance has been raised in this debate. Like many other people, I have shopped around. People must ask themselves whether they can afford a certain level of cover but it may still cost them approximately €200 per month. That amounts to €2,400 annually, which I can afford for myself and my mother but it is becoming increasingly expensive. Many people, both in and out of work, have had to forgo their medical insurance which is putting significant pressure on the system. We need to look at that issue. I ask people who are covered by the VHI, BUPA, Aviva, Quinn or any other insurance company to shop around. If they do not do so they may become hostages to fortune. It is nice to have the option to shop around.

People are now monitoring how they heat their houses in order to save money. They may heat one room instead of heating five or six unoccupied rooms. We are now beginning to realise that heating costs hit our pockets. I wish it were not so, but we must all look at this situation.

I recently attended a meeting of the British-Irish Parliamentary Assembly in Donegal, the constituency of the Acting Chairman, Deputy McConalogue. I asked where these woodchip fuel stoves have come from. In every house, they are like a little baby in the corner and people say how fantastic it is. However, these stoves have been available for the past 20 or 30 years in Germany and elsewhere in continental Europe. Yet we are only embracing these concepts now because we thought that wood, turf and other fuels were free. They are not free, however, because somebody must cut the turf.

The Government will not let us cut turf any more.

There has been a lot of innuendo, as well as untruths, about what is happening with turf cutting. The good news is that 800 people in County Roscommon alone will be paid €1,500 per year, tax-free and index-linked, for the next 15 years and will also receive €500 for signing on.

It is like taking the queen's shilling.

They will still own their own bog. If they do not wish to take that option, many have offered to join in relocation. Many of those who have been relocated are very happy. They have been relocated to another bog which is not a special area of conservation or SAC. They will also receive 15 tonnes of turf, delivered to their door every year. One man has told me that it is far too much. This situation was introduced in 1997.

Moreover, the previous Government, of which Deputy Mattie McGrath was a supporter, stated there was a derogation. However, three months into the lifetime of the current Government, I went to Brussels to meet the Commissioner, Mr. Potonik. I had travelled there to make the case that an additional six months were required to try to work with the turf cutters on this issue but when I told him a derogation had been in place for the past ten years, Mr. Potonik, who was with his officials, asked what derogation. The Government of which Deputy Mattie McGrath was a supporter, simply had told a complete untruth. There was no derogation and indeed-----

Like Roscommon hospital.

-----Deputy Ó Cuív admitted on the day that he had got it wrong. We got it wrong because solicitors' letters were coming through the door and this was a Government of which Deputy Mattie McGrath was a supporter. The last Government did not act until effectively we were in a situation in which we were obliged to comply.

It did not close the hospital in Clonmel or Roscommon.

If Deputy McGrath wishes to so do, I will bring the issue down to Roscommon County Hospital. If he wishes to accompany me, I will be going down tonight and I will bring him there.

I would love to.

He can come to see a hospital that actually is busier than it was in 2010.

What about the letters the Deputy wrote?

Under the current Government, patients are safer because, effectively, HIQA could not allow fewer than 20 people a day, out of the 5,000 people who live in Roscommon town, use a hospital. The truth also will come out in this regard. I can guarantee Deputy Mattie McGrath that patients are safer today in Roscommon than was the case in 2010. The hospital will be five times busier than it was in 2010 and will be twice as big. I hope Deputy McGrath will be man enough to stand up and thank Deputy Frank Feighan and this Fine Gael Government under the Minister for Health, Deputy Reilly, as well as the Minister of State, Deputy White, for doing what is right. This is because what went out there was the greatest untruth to have happened in this country. Unfortunately, as the only Government Deputy in the constituency, I have been holding the line.

The Deputy sent out letters to all his constituents.

Moreover, for two years, Government Deputies, who were members of Deputy McGrath's then party, stated that Frank Feighan-----

The Deputy sent out letters to all his constituents-----

Hold on Deputy McGrath. They called Frank Feighan a liar. I believe that in the past two weeks, those people should hang their heads in shame because I did not lie and have never lied in my life. I told the truth but what will come out in three or four years' time or even in three or four months' time? The hospital is ready to seek planning permission for the endoscopy unit. Deputy McGrath should come down and he and I will talk about Roscommon hospital eventually. I will take great pleasure in ensuring that patients in County Roscommon, as well as in Roscommon town, will be safer than was the case two years ago. This is and will be the truth, which is a simple fact that will be put on the record of this House. The endoscopy unit will receive planning permission in the next week or so. Moreover, one should remember there is in place both an air ambulance and paramedics. Lives are being saved and that is what the Government will do.

I will turn to a few other issues that have been discussed. Many people have spoken of how the elderly must be protected. I accept this and appreciate that Deputy Mattie McGrath has given me space to be heard because, while I digress a little, unfortunately what happens in respect of turf cutting, health and so on is there is absolute and complete hysteria. Everyone can appear on local radio or in the newspapers and everyone can write a letter but, ultimately, I speak as a Government Deputy who must deliver patient safety and the future of health services in a county that is very annoyed, and rightly so, but the truth will win out. The issue of fuel was mentioned and a few weeks ago I raised an issue in this House and around the country in respect of a European Union judgment pertaining to Irish pensioners living in Ireland who have a United Kingdom pension or who have some work-related link with the United Kingdom. Any person who was born before 1 July 1951 is now entitled to claim for the United Kingdom's fuel allowance.

When is the closing date?

The closing date is 31 March. I have sent out tens of hundreds of applications. I pay tribute to the Irish people who went to work in the United Kingdom. I have taken great pleasure in sending such applications to people from Kerry, Donegal, Monaghan, Tipperary, Clare, Roscommon and nationwide. These people were not afraid of work but went out and built up the United Kingdom and when they contact me, I send out the forms to them. It is wonderful to encounter people who appreciate one is highlighting their ability to apply for a fuel allowance in the United Kingdom, which I believe to be worth up to €300. I am delighted to be able to highlight this anomaly and to be able to tell people they are entitled to apply for the United Kingdom's fuel allowance and am delighted they are so doing. Once again, I am delighted with such appreciation from people who never sought anything over their lives. They built up the United Kingdom, as well as this island of Ireland, they work for themselves and are delighted they are getting something back, which is nice.

The Government is engaged in a stocktaking exercise and I have no doubt but that the Minister of State, Deputy White, is committed to this process. Vulnerable elderly people over 70 should not be left without a medical card or a GP card. Effectively, what went on heretofore was whatever one was having oneself. As I noted, multimillionaires and multibillionaires were entitled to free medical cards, just as were people in receipt of pensions of €170 per week. That is inequitable and is unfair and I am confident the Minister of State will ensure this does not happen.

Finally, there was something of a hoo-hah in the budget a few months ago regarding a reduction in the telephone budget. Eircom and the other telephone service providers were able to provide telephone services for €60 or €70 because no one questioned it. Now, however, Eircom has offered a new telephone service for €19.99 per month. There was no sign of such a service until this Administration decided not to give people money to give money to Eircom, the ESB or whatever. The Government decided to give what it judged to be fair. Eircom subsequently was in a position to reduce its charges and hopefully Bord Gáis and all the other utilities will follow suit. Once again, however, if the Government provides €200, it is akin to negotiating with a builder when building a house. During the good times, builders always used to ask how much was one's mortgage. The builders then took away that mortgage, thereby obliging one to seek more money from the bank to pay for furniture and the garden. Effectively, the current Government is asking the pertinent questions and is coming out with what it considers to be a reasonable amount. It then is up to the utility companies to match that, which is what I believe has happened. I wish the Minister of State well in respect of medical cards.

I also am delighted to be in position to speak on this Bill. Before he leaves the Chamber, I thank Deputy Feighan, for whom I have a lot of respect, and I am not scoring points with him at all. I am familiar with the position regarding the hospital but he knows as well as do I that dealing with HSE officials and so on is extremely difficult. One does not get proper information and all Members come under pressure. In addition, Deputy Feighan made many valid points with which I agree completely. Cards were given out willy-nilly like Christmas cards but people got gold cards for 20 years from the State body and from the Department. Moreover, neither Deputy Feighan nor the Minister of State ever objected to it. Consequently, everyone must take some share of the blame. We all went mad and that was never right. It was ludicrous that the Department was unable to conduct a proper assessment at the time and we now are paying the price for it.

Before Deputy Feighan runs away, I was present on the day when the grey brigade came to the church down the road, whose name I cannot recall, during the lifetime of the previous Government. I went there accompanying my good friend, the former Minister of State and Deputy, Seán Connick, and we met extremely frustrated and annoyed people. Moreover, I was out that evening, when the former Minister of State, Máire Hoctor, was on the podium. At the time, I saw several Fine Gael Deputies - I do not include either Deputy Feighan or the Minister of State, Deputy White - on the platform agreeing with people. Unfortunately, a game has been played in this regard.

I was not there.

No. My point is this is what happens in opposition and it touches on the issue of responsible Opposition and Government. While one might suggest that I am negative and oppose many things, I do not oppose this measure. I oppose many things the HSE does but in this case, I believe there must be a reason and it is necessary to cut our cloth according to our measure and, consequently, this issue must be examined. However, doing it in a knee-jerk fashion, as was done that time in the budget, caused holy war - if Members will pardon the pun - in that church that day. I never saw anything like it and it was quite frightening. People became animated and upset and much unnecessary anxiety was caused.

I acknowledge it was badly handled when the then Government announced people were obliged to give back the cards or they would be taken back. People who had them in their wallets took them out and showed them to me. They had these cards they had acquired from the State in their handbags and purses. These were people who were over 70, who had paid taxes and had worked in Ireland and elsewhere to build up their economies and had been given this gold-plated card, as they called it. Incidentally, I note the cards were even gold coloured.

They felt they had something, so where is the trust and the bond? It was simply announced as part of the Budget Statement that they would be taken from them. We calmed that situation down and produced new figures.

I still believe the threshold was quite high at €700 for a single person and €1,400 for a married couple, and I made that case at the time. I know many working men and women, with perhaps three or four children or even more, who have an income of half that amount of money. They might have nearly €400 in disposable income, but they cannot get a medical card. As everybody knows, children get sick and prescriptions are very expensive. There was a total imbalance. When we rowed back at that time under pressure we left the threshold too high. I will be criticised for saying that. There is no point in millionaires having a medical card. They do not need it.

The general practitioners, GPs, must take a share of the blame as well. I heard a GP speaking on the radio a couple of months ago about elements of the sick pay schemes. The GPs will have to pony up and level with people. They must tell them to stop coming into the surgery. I do not mean this badly but I know people who go to mass in the morning, call to their GP, go to the chemist, buy their few groceries and then go home. It is a type of social event. That is happening. They are lonely and isolated people. The doctors should tell them to call once a fortnight or once a month, unless they are sick. I have seen this happening. We all do when we are out canvassing. We call to the health centres and see what happens. I am not saying those people are doing anything wrong. They are entitled to do that, but what if they had to pay for it? When a child is sick, my wife will ring the doctor. She is a nurse, so she is better qualified than I am, but she will ring first because it costs €50 or €60 for a visit. Then one has to wait to see the doctor, which is the most ironic part. I have often rung on a Monday morning about a child who has been sick since Saturday or Sunday night only to be told to come in on the Tuesday morning at ten o'clock. In the meantime, one has a screaming child. That is the other aspect of this, when the doctor's office is full of people who do not need to be there. The GPs have a big role to play in this. With the roll-out of special centres for medical care, we will have to deal with this issue because it is unacceptable.

I have visited houses when canvassing, just as the Minister has. I have often been brought into a kitchen or parlour where press after press, even cabinets for good delph and china, are full of tablets. The tablets have been hoarded, unused, which is quite dangerous. They should have been returned to the GP for charities or to be sent abroad if they are still safe for use. They are dished out by the chemists when the Government is paying for them. We must examine this very carefully. We must be responsible about it but we must deal with it effectively. I am disappointed, as is always the case with the Department of Health and the HSE, that there is very poor consultation with the stakeholders.

Deputy Feighan commented about telephones and units. I was on the communications committee under the last Government. ComReg has failed to stop the ESB and Bord Gáis increasing charges. Each time they sought an increase the regulator allowed it. The savings should be made in that area. Deputy Feighan said that Eircom has announced a package for €19.99, but that is quite useless. It is only for a limited number of local calls. It is not the same as what people had previously. Those companies' representatives should be called before us. We are in a recession and we need them to decrease prices. However, every time they ask for an increase from the regulator, or the supposed regulator, they get it, regardless of the amount they seek. Bord Gáis has secured several increases in the past 15 or 18 months, as has the ESB monopoly.

Unfortunately, the same will happen with An Bord Uisce. As I have said previously, the only thing I like about that body is an t-ainm, An Bord Uisce. Úsáidim beagáinín Gaeilge agus tá Seachtain na Gaeilge ann anois. Aside from that it means less empowerment of the people. The Minister knows that as well as I do. He and I have been in council offices looking for water connections for people and support for the many group schemes that pioneered water projects, before the councils took them over. Many people have leakage problems and so forth and we are the go-between for them. Once responsibility is given to An Bord Uisce, it will be like what happened with the HSE. I am sorry but there will be no more accountability. Bord Gáis has handed over its own franchise for maintaining the gas service to Balfour Beatty. Now there are problems with staff and the companies. I do not mean to divert from the content of the Bill but that is a fact of life.

Bigger is not better. We saw what happened with Student Universal Support Ireland, SUSI, this year. It was an unholy mess. When one looks at how county councils and vocational education committees dealt with grant applications, one can see that the entire system went off on a tangent, and there was no accountability for it. There was also no understanding and, above all, no feelings for the people.

As previous speakers have said, people will get sick if they are cold in their houses, if they do not have security and if they are turning off security lights because of the cutback in the free scheme. We thought we had a land of plenty and that the pot would never run dry. However, it did and we must be responsible about it. Many of these people are very frugal and responsible. They might only have a single bar electric fire switched on. They do not waste. In fact, the schemes initiated by Sustainable Energy Authority of Ireland, SEAI, are helpful in those cases for saving energy. These people have worked and paid their way. They should not be penalised for that.

The history of the medical card for people over 70 is a mess. There is the cost of the medical cards for the over 70s and the type of medical cover provided. Many speakers have referred to private health care. I have a big family and the cost of mine is €6,000 per year, but it provides less and less cover. People are being forced out of private health care. As I said this morning in the House, people with mortgages are now being told by the bankers to get rid of their health insurance, their second car, their Sky subscription, which I do not have, and their broadband. What will they be left with? We must be careful. Then the health system is coming under more pressure because they are sick and going into hospital, thus clogging up the system.

There must be joined-up thinking here. While we must deal with the issue there must be consultations with the stakeholders. We must also have a tamer or more compassionate way of consulting and talking to people, rather than announcing this, that and the other and frightening them. That is what happened in 2009 with that announcement in the budget and all hell broke loose. Look at the anxiety that was caused. After criticising them a short while ago for a very valid reason, I salute the GPs for continuing to supply the drugs and continuing their visits in that interregnum when there was a great deal of anxiety.

We must deal with the drug companies. The pharmaceutical companies are among the best employers in Tipperary but we must deal with them effectively. We are only skirting around the edges and tickling them. There are vast profits in that sector and vast savings to be made. That is what we must attend to first. We must expose all the foreign trips by consultants and others promoting these drug companies. Half of that money should be kept at home. Cut the waste and give the services to the people.

The introduction of free GP care for all is another failed promise. It has been slowed down by huge problems. The introduction of universal health insurance is planned for 2016. The Minister says it will effectively end the two-tier health system. I do not think I or any of the other Members will be in the House when it happens. It is not going to happen. The financial situation will not allow it. It is imaginative and ambitious but there are too many vested interests. The biggest of them are the HSE and officialdom.

The Minister should cut out half of the baggage and red tape and deal with the issues effectively. He must deal with the drug companies, their prices and the prices and charges of consultants. What consultants are charging for any hospital procedure under the private health care system is just staggering. I recognise the good work that is done in hospitals but the charges are staggering. It is not a cash cow that can be milked over and over again. The game is over and the sooner people see that, the better.

Reform is required because the evidence is that user fees are a barrier to accessing care at primary care level, thereby causing late detection of illness, poorer health outcomes and greater pressures on acute hospital long-term care systems. The over-70s do not abuse the system and never have. They never had much, lived frugally, worked hard, educated their children, paid their taxes and are law abiding people. Age Action Ireland is one of the bigger representative groups. The HSE and several other Departments are funding many of those organisations. Look at the waste in that regard. Some of them have little to do. They set up offices with chief executives and a plethora of officials, but they are not serving on the ground.

I salute Muintir na Tíre. Why was it not consulted? It was founded by the late Canon Hayes in County Tipperary more than 50 years ago and does tremendous work.

I served on its board for a number of years. It works at the coalface with community alert and also did minor repair works and provided great value for money for people who received grants from the Sustainable Energy Authority of Ireland. During a blizzard two or three years ago, many of the organisations to which I referred, which had established helplines, were forced to refer callers to the Muintir na Tíre helpline because they did not have staff to deal with problems. Civil Defence, the Garda Síochána and many general practitioners dealt with problems whereas the organisations in question, despite being relatively large, placing major advertisements and offering free telephone numbers, could not tell people which towns and villages were in the county, not to mention providing any other information. Muintir na Tíre and community alert have 1,700 local organisations. I manned the former's helpline on the odd Saturday or Sunday for a short time and it was open for 24 hours per day. It was ironic that callers were referred to this helpline by other organisations which did not answer calls 24 hours per day. This is also the case in many other areas. For example, it is not possible to contact a social worker from Friday evening until Monday morning, other than in exceptional cases.

We must examine where the funding is going in some of the organisations that are always consulted. While they may have a large staff who enjoy good careers in a Dublin headquarters, they are not familiar with the facts on the ground, unlike Muintir na Tíre. As I stated, some of them were found out recently, which is no harm because they do not provide a service. While these lobbyists tend to be represented at various round table discussions, including national wage negotiations, because they can surf the Internet and know how to be in the right places, they are not delivering services on the ground. This issue must be examined to ensure money is allocated to the appropriate organisations. We must not continue to waste money in many areas.

On the revised income limits, I ask people to be practical and honest. Even in the rare cases where two parents are working, a family will find it difficult to survive on their take home pay after taxes, PRSI, pension levies and everything else have been deducted. They face significant costs if a family member becomes sick, and many parents will not visit a doctor because they want to save money for their children. That is the unfortunate reality. For this reason, everybody must share the load. I ask my colleagues to consider the proposal in a calm, cool and collected manner. It does not involve a massive reduction in thresholds and must be viewed in the context of the unholy mess created in 2009. Deputies should speak to community welfare officers because they know what is wrong in the system. Joined-up thinking is needed and efforts must be made to eliminate some of the scandalous abuses in the community welfare system. Any Deputy worth his or her salt will know what is taking place in his or her constituency because one can see prams that have been left outside health centres by people who have been given new ones. The Minister of State and I must buy prams for our children and pass them on. This is a racket involving reckless people and it should have been stopped long ago. Given the waste that is evident in many areas, the elderly must be the last people to be touched.

I thank Deputy Frank Feighan for raising the position of those who receive the Queen's shilling - a term I used earlier to describe another group - because they worked in England and receive a British pension. Two weeks ago, I listened to a discussion on a radio show. People rang up to say time was running out to submit applications for an entitlement in Britain because the closing date for receipt of applications was 31 March. People are not aware of this issue, especially older people. I do not mean to imply older people are illiterate but many need help filling out the relevant forms because they can be intimidating. I appeal to the Minister for Health to speak to his counterparts in the European Union to extend the deadline for the receipt of applications under the scheme to which Deputy Feighan referred. People are not aware of it and I must admit I first heard about it on the radio recently. The current pension arrangements between Ireland and the United Kingdom are reasonably effective.

Deputy Feighan also referred to turf cutting. I was not taking a snipe at him earlier but turf is not only a source of heat.

Turf cutting does not arise in this debate.

In my area, one would not go near the bog when the fog was low on the hill.

The Deputy will not go near it today either.

Turf cutting was a pastime and saving the hay and going to the bog were summer activities. I often went to the bog and brought turf home for people.

I cannot find any reference to turf in the Bill.

Deputy Feighan raised the issue when the Ceann Comhairle was not present. In any case, sin scéal eile and I will not dwell on it. Turf cutting was a social activity and people had turbary rights when we still had the old landlord system. Fears were stoked up about this issue. While the bogs within my old constituency were not affected, some within the new boundaries of my constituency were affected. The issue must be addressed through consultation and common sense. The same applies in the case of this legislation. Stakeholders must be consulted. One should not publish a Bill and deal with the consequences afterwards.

I thank the Ceann Comhairle for his forbearance. I ask the Minister of State to address the points I raise. The Government should insist that utility companies are tackled first. What is the point of the Commission for Energy Regulation if every increase sought by the ESB and Bord Gáis is approved? There is still a large amount of fat to be cut in this area and that should be done before cuts are made to the front line. I am not preaching to the converted when I say that all Deputies have been guilty of trying to get more for our constituents, rather than saying "No". The Ceann Comhairle will probably be shocked to learn that I support a Government Bill.

I am totally independent.

I appreciate that. My concern is that the Ceann Comhairle may believe he is hearing things. We need to prune and tidy up the system. I hope that view will be accepted in the spirit in which it is offered.

I welcome the opportunity to speak to the Bill and raise a number of pertinent issues, as previous speakers have done. It is important the legislation would address a number of anomalies. However, a number of other anomalies which I will bring to the attention of the Minister of State are not addressed. These gaps in the system deny people, especially people with incomes slightly above the threshold, the right to a medical card. The working poor are highly aggrieved because they believe they are not entitled to anything but must pay for everything. They are not entitled to a medical card or general practitioner visit card, while others, who have more disposable income and, in some cases, greater gross income, are legitimately entitled to a medical card under the current rules.

I will provide one example of the type of an anomaly that affects older people. The income limit for a medical card for an older couple aged more than 70 years is €298 per week. A couple who are in receipt of the maximum contributory old age pension, which is €230 per week each, in addition to the half rate of carer's allowance, will have a total weekly income of €562 per week. A couple in this position will receive a medical card because all of their income comes from the social welfare system, even though it exceeds the €298 income limit. However, the position is different for a person with a similar income if part of it is provided by the social welfare system in the United Kingdom.

Since the pension is coming from the United Kingdom it is calculated as income and not disregarded, as it would be for an Irish social welfare recipient. Such a person's income could be below the threshold and their sole income could be from social welfare but they are denied a medical card because some of the income comes from a contributory social welfare payment in another jurisdiction. That anomaly probably contravenes EU law and needs to be clarified and addressed.

A more frustrating anomaly relates to the working poor in this country. The purpose of family income supplement is to support low income families and encourage them to stay in work. The family income supplement element of their income is disregarded in the means test for the medical card but the supplement could push their total income over the income threshold and cause them to be denied the medical card. Meanwhile, someone who is considerably over the income limit but whose income comes solely from social welfare will qualify. The system is being turned on its head. It penalises people who are in work in favour of others whose sole income comes from social welfare and discourages people who are on social welfare from going back into employment. I accept that there is a transition period, the purpose of which is to iron out anomalies. Nevertheless, consider two neighbours living side by side. Both are on, pretty much, the same income but one gets up every morning and goes to work, if they are lucky enough to get employment, while the other does not even attempt to find employment. What is the incentive for either of those neighbours to go to work? They may get a few extra euro but they will lose their medical card in three years time, or the law could change in the intervening period. The ethos of the medical card needs to be addressed.

Consider another example. A single person in receipt of disability allowance of €188 per week as well as the half-rate carer's allowance is entitled to a medical card. Someone in employment and earning €290 per week, which is less than the first person's income, is denied a medical card. The system is wrong. Some people who are just over the income threshold get nothing while others who are significantly over the income threshold, because their sole income is from social welfare, are entitled to a medical card.

I am also frustrated by the roundabout way we have doctored the income threshold for the medical card over the past number of years. The income threshold has not increased but, because of budget changes, the cost of attending hospital has gone up and the payments people have to make until the drug refund scheme kicks in have increased. The medical card system allows no formal recognition of that. More and more people are being pushed into this poverty trap. This needs to be addressed. The Bill, while it deals with anomalies, does not deal with several genuine anomalies which incentivise people to give up employment and go into social welfare system.

When the Minister of State replies to the debate, I hope he will deal with the issue of granting only GP visit cards for the long-term illness scheme. The original Government announcement was that those covered by the long-term illness scheme would receive medical cards. That has been watered down and they are to receive doctor only, or GP visit, cards. Can the Minister of State give us a timeline for that change?

When the Minister brings forward that legislation, I suggest that it be extended to other long-term illnesses, such as haemochromatosis, that are not now covered by the scheme. Policy decisions were taken by a series of Governments not to entertain any extension of the long-term illness scheme. Illnesses such as haemochromatosis should be included in the scheme. This disease does not involve any additional costs, other than the out-patient charge, so sufferers would benefit from having the GP visit card. They are a significant proportion of the population. Other long-term illnesses, including colitis, have been mentioned by Deputies on this side of the House. Recognition should be given to them.

The vast majority of children with life limiting conditions will never see their 15th or their 18th birthdays. There is a small number of these children, approximately 1,500 per annum, and many are probably in receipt of the medical card, either on means grounds or because of their medical condition. A small cohort do not have the medical card. It would be some recognition of these families if they were included in the scheme. I will raise this matter with the Minister when the legislation comes to the House in the next number of months. This needs to be addressed.

A person who is aged 70 or over and is no longer within the income threshold can apply for the ordinary medical card. Other issues, which are not taken into account for the over 70 medical card, will be considered. However, the discretionary medical card, which traditionally was given in cases of medical hardship, has been greatly curtailed since the primary care reimbursement service, PCRS, took over the provision of the service. I have significant experience of such cases over a long number of years. The HSE took a pragmatic approach to them and took into account the genuine costs involved in attending medical appointments and so forth. It is now nearly impossible to get any movement from PCRS. When we do get movement, in the vast majority of cases people are issued with a GP visit card rather than a medical card. In many of these instances the additional hardship relates not just to medicines, but to frequent visits to hospital and to consultants in Galway or Dublin. Additional financial costs are associated with that, especially since the withdrawal of transport support from the HSE. The closure and downgrading of hospitals such as Roscommon County Hospital is forcing more people to travel to avail of services.

With regard to Roscommon County Hospital, I must dispute claims that Roscommon hospital is busier today than it ever was. This is load of rubbish, as the mathematics show. That is all I will say on that matter. I do not want to get involved in that debate because it is not relevant to what is in front of us today.

The discretionary medical card is, slowly and surely, being withdrawn. Where there are cases of genuine need a GP visit card only is issued. I ask the Minister of State to look at that situation. Families who suffer significant financial hardship need a medical card.

In many cases, having free access to a general practitioner will not deal with their financial hardships in a substantial way. It is probable that they also see a number of consultants, which incurs additional costs - consultants' fees, inpatient costs, transport, lost earnings, etc.

I hope that the Minister of State will consider my point on the long-term illness scheme.

A proposal has been put to the Minister regarding the establishment of a national fund for sick children with life-limiting conditions. It would save money for the local offices of primary, community and continuing care, PCCC, services. The HSE is spending approximately €47,000 per annum per child through its various local offices. This figure could be reduced by half if there was a national office to control services. It would provide consistency in the provision of services for children with life-limiting conditions across the country. In my county, a white line in the middle of the road is the provincial dividing line. A child on one side gets access to a certain level of services while a child on the other side has a different entitlement.

I hope we can deal with the anomalies in the system across the country. The primary care reimbursement service, PCRS, in Dublin is doing so in respect of medical cards, but the same cannot be said for children with life-limiting conditions. Everything depends on the local budget, the attitude of the local health office manager to a particular case and families' persistence in pushing their cases. Sometimes, parents whose children are sick do not have enough energy or time to push as hard as they need to. A child with a lower level of dependency can get a higher level of support purely because a family has access to someone who can do the pushing or who has the wherewithal to articulate their case well. This is not right, particularly given our limited resources.

HSE offices spend approximately €8.2 million per annum. At a launch in the Mansion House on Monday of last week, however, it was estimated that a budget of €5 million would provide the necessary services. I have provided the details to the Minister for Health. After today's debate, I will send a copy to the Minister of State, Deputy White. By taking this service out of local offices and centralising it in Dublin, a significant amount would be saved and a better quality of service could be ensured for children, some of whom will live for a week, a month or one, two or three years.

As public representatives, each of us has encountered heart-wrenching cases. We must roll up our sleeves and try to fight for them. Deputy Connaughton has entered the Chamber. He and I dealt with a case in which we wanted to get a child home before last Christmas. A parent should not need to ask one, two or three public representatives to obtain these rights, particularly when the overall national pool of funding is adequate to deal with the issue. How the money is distributed and the lack of consistency across the country seem to be causing problems. I urge the Minister of State to consider this matter.

A further issue arises in respect of the analysis of this legislation, namely, the substantial number of older people who have private health insurance. Many also possess the over-70s medical card. At a time when the private health insurance system is haemorrhaging families - 64,000 people left last year and, according to a recent survey, one in three families plan to give up health insurance this year - it is bizarre that more older people are buying it for the first time. If we keep going as we have been, those who can afford insurance - the wealthy - and those who cannot afford not to have it - the very sick - will be the only ones left in the system. There has been a failure to recognise the crisis. This trend will place an additional burden on the public health system, which is already creaking.

The problem is not the treatment that people receive once they enter the system. Rather, the problem is accessing that treatment in the first place. While it must be recognised and welcomed that waiting lists for inpatient procedures have shortened, the waiting lists for outpatient appointments have grown longer. This crisis is worsening. If we force people out of private health insurance and into this system, the problem will be compounded.

Will the Minister of State consider the legislation passed by the Houses in the early 2000s to introduce lifetime community rating? It would be a step in the right direction and would provide young families and people with an incentive to join health insurance schemes for the first time instead of waiting until they are 55 or 60 years old, which is currently the case.

I thank Deputies for their contributions on the Bill. It has been an interesting debate. The maintenance of health services is a priority for the Government in 2013 despite the undoubted need for significant and difficult financial savings to be made in the health sector. It has been our intention that front-line health services be protected to the greatest extent possible. None the less, as has been acknowledged, €781 million in savings must be achieved in 2013. This cannot be avoided. The majority of the savings have been designed not to affect front-line activity.

In the context of this Bill, it is vital that the key message I outlined yesterday be repeated: 95% of people above the age of 70 years will not be affected by the new arrangements. With respect, this should provide a level of reassurance and comfort to the majority of people aged over 70 years. We have also sought to minimise the impact on the 5% affected, who earn €600 per week as individuals or €1,200 as couples. We will continue to ensure that they receive free GP services.

To be clear and so we understand precisely what we are debating - we can disagree on the merits of it - 5% of people will be affected. The change is that people will lose access to a full medical card but they will all have a GP visit card to replace it. All - not some - of the people who are above the new eligibility limits of €600 for an individual and €1,200 for a couple, respectively – we estimate there are 20,000 such people – will receive and have access to free GP services. What they lose out on is the contribution to their drug costs, which they will no longer be able to access as they will not have a full medical card, but it will be capped at a level equivalent to €36 per week under the drug payment scheme. I do not seek to minimise the effect the change might have on some individuals and couples but I seek to remind the House of the precise and factual position of what is being done. It does bear repeating and emphasising the relatively small number of people who are affected by the change and the fact that every single one of those people affected will have a free GP visit card.

Deputies Kelleher, Ó Caoláin and others advanced the argument that this change is inconsistent with Government policy in respect of universal free GP care. That is not at all the case. If I were to propose that individuals would lose access to free GP care and that we were taking something away in the Bill that we were proposing to make available in the universal GP visit card which we intend introducing – giving with one hand and taking away with the other – then there might be some merit to the argument but there is no merit to it because what we are doing is not inconsistent at all. We are not removing the GP visit card from anyone. The suggestion of Deputy Kelleher that what is intended is at variance with Government policy or inconsistent with it does not hold water. That is the factual position. Am I wrong in that? It might be funny but it is correct.

With all respect to the Minister of State, he is seeking respect where there is none.

Currently, 360,000 medical cards are issued to people over 70. Therefore, medical card coverage of the over 70s population is approximately 97%. In comparison, the medical card coverage of the under 70s population is approximately 35%. As I outlined yesterday to Deputies, it is estimated that approximately 20,000 people will have their medical card replaced with a GP visit card. That is the factual position.

I wish to correct one or two issues so we are clear on what precisely is in the Bill rather than a particular take on it that Members might have unwittingly picked up. Deputies Kelleher and Browne referred to section 7(5) which states:

The Minister shall, on 1 September of every year, review the most recent information on the consumer price index made available by the Central Statistics Office, and may, with the consent of the Minister for Public Expenditure and Reform, by regulations to take effect on 1 January next following that review, increase or decrease the gross income limits specified for the purposes of this section to reflect any increase or decrease in that index.

It is clear from the provision that the power given to the Minister to increase or decrease the limits by regulation is predicated entirely on the most recent information on the consumer price index, CPI, in any given year. There is no right residing in the Minister, or any Minister from this side or the other side, on the basis of the legislation to introduce such change in a whimsical way or on some basis other than the CPI to change the income limits and eligibility. That is a misreading of what the section says. It is important that is placed on the record and that people are clear on precisely what is proposed.

A number of Deputies referred to the savings that will arise from the changes. One or more colleagues described it as nit-picking that €12 million would be saved in this year and €24 million in a full year. I find such an argument difficult to understand. Most of the individual savings that must be achieved across the board are relatively small amounts compared to the €780 million. In other words, one is talking about €24 million, €30 million, €50 million, €10 million or €5 million. It does not serve the House for us to say that because the saving is “only” €12 million in a year or “only” €24 million in a full year that it is nit-picking and that it can be set aside. We cannot operate on that basis because the same argument could be made about every single element of the savings that, regrettably, have to be made. There is not much point in dwelling on that argument because if that were the case then we would not be able to make any savings at all in the budget we must address.

I agree with much of what has been said in the course of the debate. Many of the issues Deputies raised do not directly relate to the provisions of the Bill. Deputies made observations on the cost of drugs. The point is well made and well taken that those issues must be addressed. They are in fact being addressed by the Government in a number of different ways.

There was much discussion about the general primary care reimbursement service, PCRS, approach to applications for medical cards, in particular discretionary medical cards. Deputies asked me to address the issue. Points were made about what happened historically. The fact is that under our system medical cards are not awarded to any particular group of patients on the basis of a specific disease or condition. That is not the position. The Act of 1970, which is the legislation under which we have been operating since, including during Deputy Kelleher’s time, is the one which governs eligibility. As everyone is aware, eligibility for health services in this country is based primarily on residency and in particular on means. That is the basis upon which medical cards are granted. The exception to that is a provision for discretion to grant a card in cases of undue hardship where the income guidelines are exceeded. It is necessary that we have a system in place for that to be assessed, where a person comes forward in good faith who has a particular illness or condition and he or she wishes to make an application for a discretionary medical card. We must have in place a transparent system we can all understand and that is properly administered by the PCRS. That is what we have done. In addition, we recently set up a clinical panel to assist in the processing of those applications. Deputies have raised issues about particular cases with which they have had to deal. I am aware of such cases myself. However, I am satisfied that the system is being administered in a sensitive, transparent and objective way. If Deputies have any reason to believe that it is not the case I ask them, through you, a Cheann Comhairle, to bring it to my attention. I refer for example to cases where appropriate sensitivity was not shown or where applications have in some way been improperly or unfairly examined. That is something I would not wish to see happen.

In addition to the discretionary medical card system there is also an emergency medical card process whereby if a person has become terminally ill a card can be issued within 24 hours in circumstances where someone is faced with such a tragic situation in his or her life. That does happen and will continue to happen. Currently, more than 62,000 discretionary medical cards are in operation in the State.

I disagree flatly with the point made by Deputy Healy-Rae. I have not disagreed as strongly with any other observations made. He said he regrets the removal of the processing of medical cards from local offices to the PCRS.

I respectfully suggest that this has been a very important, successful and progressive move. We previously had 100 local offices across the country processing applications for medical cards. What we now have is a centralised system that provides enhanced service delivery to clients and ensures a consistent and equitable national assessment process that everybody can rely on. Surely that is what we all want. We want a system that is consistent, effective, efficient and transparent, and that is what we have now. Ninety-five percent of medical card applications are now processed within 15 working days, which is a major achievement. Deputies might say that should always have been the case, and I would not disagree, but at least we have achieved that in a relatively short period of time. Before we centralised the medical card applications system, it was impossible to say how long it would take for an application to be processed. Now we have both transparency and efficiency and we should welcome that.

On the issue of community welfare officers and the local input to which Deputy Healy Rae referred, it is true that CWOs no longer have a role in the medical card application process. However, it is important to emphasise the fact that staff in local health offices continue to provide information and assistance to individuals in connection with their medical card applications.

We have had a very good Second Stage debate on this Bill and the contribution of Deputy Twomey, in particular, was excellent. I agree with what he said about the need for a serious debate about issues such as universality and how we fund our health services. I am a strong believer, as is Deputy Ó Caoláin, in the principle of universality in the provision of health services. However, we sometimes throw around these words and phrases like slogans in this House and spend most of the debate talking about who said what on the back of which truck during the general election campaign. I often think that we should set aside one day in here during which I would commit to not criticising Deputy Ó Caoláin's party for its inconsistencies vis-à-vis the North and the South and, in turn, Deputy Ó Caoláin would not say anything to me about what my party said in the general election campaign. I would not criticise Fianna Fáil for wrecking the economy and making it so difficult for us to put it back-----

That would be very difficult to do.

I am actually making a serious point. We could take one day, say in July, and agree to abandon all of that and just talk about the health services and how we fund them - a day when there would be no ad hominem attacks at all and we would just discuss what is best. On the issue of universal health insurance, Deputy Kelleher, instead of just asking "Where is the brief?" or "Where is the proposal?" would tell us what he thinks about how it should be done. Deputy Ó Caoláin could do the same, because it is not as straightforward as some might think. More could be achieved in this way than through the kind of brickbat debate we have had on this legislation. This is necessary legislation, which encompasses a relatively-----

It is U-turn legislation.

It is far from a U-turn. The Deputy was not listening to the point I made earlier that we are continuing with our absolute commitment to the universal provision of GP visit cards. No one will lose a GP visit card under this legislation, so it is not inconsistent with that principle.

The issue is primary care. This legislation is unnecessary.

Question put:
The Dáil divided: Tá, 65; Níl, 35.

  • Bannon, James.
  • Byrne, Eric.
  • Cannon, Ciarán.
  • Carey, Joe.
  • Conaghan, Michael.
  • Conlan, Seán.
  • Connaughton, Paul J.
  • Conway, Ciara.
  • Coonan, Noel.
  • Coveney, Simon.
  • Creed, Michael.
  • Daly, Jim.
  • Deering, Pat.
  • Doherty, Regina.
  • Donohoe, Paschal.
  • Dowds, Robert.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • Farrell, Alan.
  • Feighan, Frank.
  • Ferris, Anne.
  • Fitzpatrick, Peter.
  • Flanagan, Terence.
  • Griffin, Brendan.
  • Harrington, Noel.
  • Harris, Simon.
  • Hayes, Tom.
  • Heydon, Martin.
  • Humphreys, Heather.
  • Humphreys, Kevin.
  • Keating, Derek.
  • Kenny, Seán.
  • Kyne, Seán.
  • Lawlor, Anthony.
  • Lynch, Kathleen.
  • Lyons, John.
  • McHugh, Joe.
  • McNamara, Michael.
  • Maloney, Eamonn.
  • Mitchell, Olivia.
  • Mitchell O'Connor, Mary.
  • Murphy, Dara.
  • Murphy, Eoghan.
  • Nash, Gerald.
  • Naughten, Denis.
  • Neville, Dan.
  • Nolan, Derek.
  • Ó Ríordáin, Aodhán.
  • O'Donnell, Kieran.
  • O'Donovan, Patrick.
  • O'Mahony, John.
  • O'Reilly, Joe.
  • O'Sullivan, Jan.
  • Perry, John.
  • Ring, Michael.
  • Ryan, Brendan.
  • Sherlock, Sean.
  • Spring, Arthur.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Twomey, Liam.
  • Wall, Jack.
  • Walsh, Brian.
  • White, Alex.

Níl

  • Boyd Barrett, Richard.
  • Broughan, Thomas P.
  • Calleary, Dara.
  • Colreavy, Michael.
  • Cowen, Barry.
  • Crowe, Seán.
  • Daly, Clare.
  • Doherty, Pearse.
  • Donnelly, Stephen S.
  • Dooley, Timmy.
  • Ellis, Dessie.
  • Ferris, Martin.
  • Flanagan, Luke 'Ming'.
  • Fleming, Sean.
  • Fleming, Tom.
  • Halligan, John.
  • Healy, Seamus.
  • Kelleher, Billy.
  • Kitt, Michael P.
  • Mac Lochlainn, Pádraig.
  • McGrath, Finian.
  • McGrath, Michael.
  • McGuinness, John.
  • McLellan, Sandra.
  • Murphy, Catherine.
  • Nulty, Patrick.
  • Ó Caoláin, Caoimhghín.
  • Ó Fearghaíl, Seán.
  • Ó Snodaigh, Aengus.
  • O'Brien, Jonathan.
  • Pringle, Thomas.
  • Ross, Shane.
  • Smith, Brendan.
  • Stanley, Brian.
  • Wallace, Mick.
Tellers: Tá, Deputies Emmet Stagg and Joe Carey; Níl, Deputies Aengus Ó Snodaigh and Billy Kelleher.
Question declared carried.
Committee Stage ordered for Tuesday, 26 March 2013.
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