Dáil Éireann debate -
Wednesday, 1 Oct 2014

Vol. 852 No. 2

Topical Issue Debate

Data Protection

Deputy Richard Boyd Barrett

This is a day of shame for the Government and a day of fear, anxiety and outrage for hundreds of thousands of families who, for the first time in the history of the State, will be charged to access the basic human right to water, on top of all of the stealth charges and taxes that have been loaded on the people to the point where many are utterly crippled financially. The anger and outrage felt are manifest in mass meetings and protests the length and breadth of the country and we are likely to see tens of thousands on the streets before the upcoming budget is announced, demanding that the Government abolish these hateful charges.

If all of that is not bad enough, to add insult to injury, Irish Water, in its efforts to force people to pay this unjust and regressive tax, is also asking for PPS numbers and personal information and data on all households in the State. This has raised very serious issues and legitimate fears about the protection of personal data and what Irish Water may do with them. Let us be clear: under the legislation, Irish Water has been designated to be a private company. Therefore, people are being asked to provide PPS numbers and personal information for a private company. Interestingly, the Irish Water website has been changed in the past few days to cover up its initial policy, but it still states the information will be used for marketing purposes, shared with agents or third parties, can be transferred and processed by staff operating outside the European economic area and Irish Water suppliers. By agreeing to submit the information, people are consenting to all of the above and the use of this detailed and sensitive personal information in these ways by a private company, its suppliers and others with whom it works.

The ESB does not ask for or require PPS numbers and, until now, Bord Gáis did not ask for them. Why is Irish Water seeking this personal and sensitive information, about which the Data Protection Commissioner said people should be careful? Specialists and consultants in the area have described the manner in which Irish Water is seeking the information as unsupportable approaches for information. The Data Protection Commissioner has said clarification is needed. This is a serious issue about sensitive, personal information being handed over to a private company that is linking the demand for the information with allowances and charges and what people may pay. This leads many to believe they have no choice but to hand over the information. How can the Minister of State stand over and justify this? What reassurance can he give that the information will not be handed over to other bodies and parties that may abuse personal information that is the property of citizens?

Minister of State at the Department of the Environment, Community and Local Government (Deputy Paudie Coffey)

I thank the Deputy for raising this matter, in respect of which I am happy to clarify the position on behalf of the Minister for the Environment, Community and Local Government, Deputy Alan Kelly.

Under the Water Services Acts 2007 to 2013, Irish Water may request its customers and certain specified persons or bodies, including the Minister for Social Protection, to provide it with information in order that the company can perform its functions under the Acts. The Water Services (No. 2) Act 2013 provides that Irish Water is responsible for public water services and can collect charges from its customers in receipt of water services provided by it. It also provides that responsibility for the independent economic regulation of the water sector is assigned to the Commission for Energy Regulation, CER, which has been given statutory responsibility for protecting the interests of customers of Irish Water.

The proposed approach to charging was outlined by Irish Water in a water charges plan that it submitted to the CER in line with the provisions of the Act. The CER recently held a public consultation process on this plan, which covered a range of issues relating to water charges and allowances. Yesterday the CER issued a determination on the water charges plan, details of which are available on its website. With charges effective from today, 1 October 2014, Irish Water is in the process of compiling the relevant data to ensure customers can be billed accurately based on the tariff structure approved yesterday by the CER.

Throughout September, Irish Water sent application packs to nearly 2 million households which refer to the effective charging date and the fact that billing for domestic customers in receipt of public water services will start in January 2015. Irish Water is in the final stages of issuing these packs. The application process will enable customers to confirm their details and to ensure that a correct and up-to-date database of customers exists. The pack is accompanied by a guide explaining why each piece of information is required. A media campaign has also been launched to emphasise the need to complete the application process by 31 October 2014.

On 6 May 2014, the Government made certain decisions relating to the structure of water charges including, inter alia, a free allowance per household and an additional free allowance for children on the same qualifying conditions as the child benefit payment from the Department of Social Protection. As these allowances are to be funded by Government, Irish Water needs to ensure it has the appropriate and sufficient information to reflect these entitlements. The personal public services, PPS, numbers will be used by Irish Water to validate that customers are entitled to any relevant water allowances. It is important to stress that the PPS information will only be shared with the Department of Social Protection and solely for this verification purpose. This will ensure that each household receives the free allowance to which it is entitled as well as any additional allowance for children in receipt of child benefit at that address. It will also facilitate Irish Water in providing reduced charges to owners who have unoccupied dwellings. Households who do not provide PPS numbers to establish eligibility will be billed a default charge which the CER has set. In the case of late validation, any relevant allowances will be backdated 60 days prior to the date of registration.

Irish Water is a specified body under the Social Welfare Consolidation Act 2005, as amended by section 20 of the Social Welfare and Pensions Act 2014 and is therefore permitted to request PPS numbers to authenticate the identity of the person being provided with an allowance. Irish Water will treat applicants' personal data in accordance with the Data Protection Acts 1988 and 2003. In complying with these Acts, Irish Water must ensure that the data is only used for the purpose for which it was collected and must also ensure that any data collected is stored securely. Irish Water has confirmed that no data will be stored outside of the European Economic Area, and Irish Water will not be selling or trading any customer data. There may be limited instances where Irish Water might need to share information with third parties with whom it has service agreements for operational reasons, for example, instances where ICT support for systems maintenance is required, and this will be done under full compliance with all data protection requirements.

Deputy Richard Boyd Barrett

It is absolutely hateful and obscene that the Minister will from today charge people for the basic human right to access water which people need to live. As if this is not bad enough, to then demand with menaces PPS numbers and other sensitive personal information is really an outrage and the Minister of State's reassurances do not convince me.

The Minister of State says that Irish Water has given assurances that it will not send this information outside the European Economic Area. I invite him to look at Irish Water's website which states:

[T]he data relating to the customer may be used for marketing purposes. Irish Water may share the customer's data with agents or third parties who act on behalf of Irish Water in connection with the activities referred to above, [which is marketing]....Data we collect ...may be transferred to a destination outside the European Economic Area ("EEA")....It may also be processed by staff operating outside the EEA....By submitting data to Irish Water, the customer agrees to this transfer or processing.

This is updated information which remains on the website. It was changed after the uproar about this issue in the past number of weeks. The Minister of State has received some sort of assurances, which I do not trust frankly, from a company that recently sent out 6,000 letters to the wrong addresses. Even if the Minister of State was given assurances that the actual PPS numbers will not be handed on, any company can garner information from the PPS numbers which could be useful to third parties. The PPS number is a key to a great amount of information even if the PPS number itself is not handed over. It is clear from what Irish Water states on its own website and what data protection experts say, that we cannot trust a private for-profit company whose assets could be sold on in the future, with this personal sensitive information.

Deputy Paudie Coffey

Given that domestic water charging commenced today, 1 October, Irish Water requires a comprehensive customer database to be in place to ensure that customers can be billed accurately, based on the tariff structure approved by the regulator yesterday. In advance of the introduction of the charges, the Government made decisions relating to the structure of water charges and agreed to provide a free allowance per household and an additional free allowance for children, based on the same qualifying conditions as the child benefit payment from the Department of Social Protection.

The collection of the PPS numbers allows Irish Water to confirm and validate those same entitlements to allowances for each customer. This is the significant point. I am concerned that it is reported that Opposition Deputies, possibly including Deputy Boyd Barrett, are advising people not to register nor to claim their entitlements and allowances. I am aware that some Deputies were holding public meetings about the local property tax and advising people not to pay the property tax and these people were subsequently subject to liabilities and penalties. Those very same Deputies said at public meetings that they would see to it-----

Deputy Richard Boyd Barrett

The Government was imposing those penalties.

Deputy Paudie Coffey

-----that they would not have to pay those charges. That is folly and it is unfair to the public they were advising. We need to be straight with people and advise them correctly, in line with the law of the land. Those people were quickly deserted and left with penalties and fines. I do not want to see that happening again with regard to water charges.

Deputy Richard Boyd Barrett

It is the Government members who are imposing penalties and putting their mates on the board.

Local Authority Housing

Deputy John Lyons

The Government is currently examining a number of measures in preparation for its social housing strategy and wider housing policy. Securing a deposit for a house is challenging for young families, in particular, given the fall in incomes and the inability to save money.

One innovative response has been the rent-to-buy scheme which can effectively allow a tenant to convert a portion or a proportion of rent paid into a deposit to buy at the end of a defined period. A three-year pilot scheme was launched by Dublin City Council in 2010 and interest was strong at the time. This model should be examined as part of a future housing and social housing policy.

One of the key points of the rent-to-buy scheme is that obligations on both the tenant and the seller are adhered to and that timetables are met. However, I know of a case in my constituency where, unfortunately, a proportion of the Dublin City Council rent-to-buy tenancy agreements have not been met. This problem must be dealt with because the scheme is a good scheme.

Approximately 64 tenants in my constituency are part of the rent-to-buy scheme. This scheme is available to people on the council's affordable housing list and is aimed in general at low to middle income families who do not fit the social housing criteria. Properties were viewed in September 2010 and tenancies commenced in the period from November 2010 until April 2011. The original terms of the scheme state that people who availed of the scheme were supposed to rent their property at an affordable rent, at 80% of the estimated market rent for three years. At the commencement of the contract the council set the terms for the future sale of the property. Eighty per cent of the rent paid by tenants over three years was to be deducted from the sale price of the property as agreed between the tenant and the council at the time. However, there had been a change to the scheme in September 2013 whereby Dublin City Council, without any consultation with the tenants who signed up to the rent-to-buy scheme, informed them of two changes decided by the council. They were informed that the properties would not be offered for sale at the market value agreed at the beginning of the rent-to-buy scheme and that there would be no deduction for rent paid over the term of the three years. The council had broken two significant terms of the agreement with the tenants.

While the lack of consultation was regrettable, it is accepted that the motivation of the council was to realign the scheme with falling apartment prices.

From the outset, the scheme should have been proofed against market fluctuations, perhaps in a way similar to that adopted by NAMA in the context of deferred payment schemes.

At no stage during the re-evaluation process carried out in 2013 and 2014 or when the three year tenancies were coming to an end were tenants informed of any delay relating to the scheme. Everyone operated on the basis that when the three year tenancies ended, the properties involved would be offered for sale and that those tenants who did not want to proceed to purchase would surrender their properties. As a result, people put mortgage arrangements in place, saved money for deposits and incurred the usual expenses relating to buying a home. It is seven to nine months since their tenancies ended, but the city council has not offered any property for sale. I understand the council is prepared to extend rental contracts to the end of this year and then review whether the technical issues holding up the sale of the properties have been resolved.

As matters stand, the 61 residents of Prospect Hill, Finglas, to whom I refer are in limbo. They do not know whether the agreements to which they signed up under the rent-to-buy scheme will be honoured or whether the money they paid in over three years and expected to be deducted from the eventual sale price agreed at the outset will be offered back to them. They also do not know whether the additional rent they have paid beyond the term of the three year scheme will be taken into account in any future deal.

The rent-to-buy scheme is a good one, but there are a couple of problems relating to it which need to be solved. I ask that the Minister for the Environment, Community and Local Government contact Dublin City Council in order to discover how effective the scheme is and in the interests of addressing the issues of concern to the people of Prospect Hill in Finglas.

Deputy Paudie Coffey

I thank the Deputy for raising this matter. Increasing both public and private housing supply is a critical issue and the Government's construction strategy, Construction 2020, published on 14 May, is a blueprint for a properly functioning and sustainable construction sector. It provides for a strategic approach to the provision of housing based on real and measured demand and addresses the full range of relevant issues, including the planning process, financing, access to mortgage finance and the construction workforce. The Government has committed, under action 8 of Construction 2020, to publish a social housing strategy. This strategy, which isin preparation, will provide the basis for an enhanced approach to social housing provision in Ireland. The strategy is being developed by my Department, with input from key personnel in the Housing Agency and the National Economic and Social Council. A public consultation process was undertaken by the Housing Agency during the summer. A wide range of submissions from key stakeholders were received and have informed the development of the strategy.

The social housing strategy will build on the strengths of the sector's key players and provide for a coherent, sustainable and reliable framework for the delivery of social housing support in Ireland. The strategy will necessarily concentrate on social housing issues, but it will also make the connection with key issues affecting the Irish housing market as a whole. It will quantify the nature of the challenge with regard to housing need, housing demand and housing supply. Based on 2013 figures, 89,800 households are in need of social housing supports. The Construction 2020 target of tripling annual housing output in the next six years further informs the scale of the challenge. A range of delivery mechanisms are being considered and the strategy will provide pathways for the delivery and financing of the increased supply of social and public housing which will be required in the coming years.

In the context of the issue raised by the Deputy, Dublin City Council launched a pilot rent-to-buy scheme in 2010. This scheme was intended to provide Dublin city with a further option for dealing with unsold affordable houses. All properties under that pilot scheme have been allocated and I understand no further offers are being made at this time. The Government's 2011 housing policy statement announced the standing down of all affordable housing schemes in the context of a full review of Part V of the Planning and Development Acts 2000 to 2013. The review of Part V of the Planning and Development Acts, which provides for social and affordable housing supply, has been completed by the Housing Agency - at my Department's request - and submitted to the Government. I anticipate that any legislative change required on foot of the review will be incorporated into the general scheme of a new planning Bill that is expected to be published shortly.

Deputy John Lyons

I thank the Minister of State for his reply. He is correct to state all units advertised by Dublin City Council were taken up under the rent-to-buy scheme when it was launched 2010. As stated, the scheme is an excellent one. It allows people who cannot afford to put aside money for a down payment or a deposit on a house to get onto the property ladder. In addition, 80% of the rent they pay on their dwellings for three years goes towards an eventual sale price agreed with the local authority. Effectively, this means that they can live in the property, in respect of which they are setting aside a down payment and which, I hope, they will be able to purchase in the future. It is a win-win for everyone involved. Unfortunately, the goalposts were moved and those who signed up to agreements have been informed by the city council that it does not know whether it is going to allow them to buy these units as a result of some technical difficulties that need to be ironed out, whether - if sales proceed - the market price agreed three years ago will apply and whether it will provide some waiver or recognition of the additional rent they have paid for seven or eight months beyond the terms of their original agreements.

If nothing else, the tenants in Prospect Hill, Finglas, should be treated fairly and consulted by Dublin City Council. If an agreement is reached, they should be given recognition for the fact that have spent over three years in their apartments and that they are currently paying rent which they did not plan to pay. They do not even know whether they are going to be able to buy the homes in which they are living. Will the Minister of State ask his officials to, at the very least, contact Dublin City Council in order to discover what is happening and ensure the 61 families in Prospect Hill who signed up to the original agreements will receive answers and be treated fairly?

Deputy Paudie Coffey

Given the concerns raised by the Deputy, I will ask my officials to engage with Dublin City Council in order to examine this issue to see if any progress can be made or a resolution found.

In the wider context, the key focus must be on significant intervention by the State on multiple fronts in order to ensure delivery and provide an adequate supply of secure, good quality housing in sustainable communities for all citizens as the country continues on the path to recovery. In the interests of ensuring short-term supply is maximised in tandem with any new-build programme, the social housing strategy will be key and include a range of actions to maximise the supply, management and maintenance of social housing stock in the longer term. The strategy will be finalised in the coming weeks and take cognisance, in particular, of the outcome of the Estimates process.

Ambulance Service Provision

Deputy Colm Keaveney

I thank the Minister of State, Deputy Kathleen Lynch, for coming to the House to listen to my concerns. I am sure she will appreciate the considerable level of concern and disquiet at national and, in particular, regional level about ambulance response times and follow-up capital investment for ambulance services in the west. She should be concerned because a recent HSE report clearly outlines that the ambulance service in the west is not performing well and that its response times are considerably out of kilter with those in other regions and international norms.

I ask the Minister of State to accept that there is a need to accelerate investment in the ambulance service in the western region which is quite large in geographical terms. The population of the region is entitled to expect adequate ambulance response times. The Minister of State will recall that the closure of the accident and emergency unit at Roscommon County Hospital was sold to us on the basis of significant investment in the ambulance service and the emergency medical technicians who provide it. I take the opportunity to acknowledge the dedication, commitment and, above all, actions of these staff. However, I request that the Minister of State consider the state of the vehicles they are obliged to use for their work. In the context of the HSE's recent figures for response times relating to clinical status 1 - echo - I also request her to investigate their capacity to operate properly. I do not wish to bamboozle people by using terms such as "echo", "bravo", etc. Suffice it to say that when someone suffers a heart attack, he or she wants to know that staff driving the vehicle with the blue lights on top will be able to get there, assist and transport him or her to hospital. The response times in Tuam and Roscommon are a source of great concern and significantly out of step with those which obtain elsewhere.

One of the underlying aspects of the support requested from the House in accepting the need to close the accident and emergency unit at Roscommon was that a world-class standard would come into being in the case of ambulance response times.

The situation is even worse for clinical status 1, which is when the service is in life-saving mode for cardiac arrest, respiratory emergencies and so on. The trip from Galway to Tuam on a blue light can take up to one hour. There is a brand new facility lying idle in Tuam but there has never been the required investment in human resources to cover what they now call in Tuam and Roscommon the Bermuda Triangle. We have no idea where the ambulance is.

I call on the Minister of State to cast her mind back to the "Prime Time" programme that investigated the matter. The Minister of State might remember the National Ambulance Service representative who said that the service did not have the people or the vehicles to meet the targets and that it was time for the National Ambulance Service to accept that the targets were unrealistic unless the cuts were reversed. Will the Minister of State make a statement with respect to my observations? Then in my two-minute slot subsequently I will introduce some of the statistical details of the report of the Minister of State on response times.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I thank the Deputy for raising the matter and I am pleased to be able to outline some of the current developments in pre-hospital service in the region. The National Ambulance Service is working to ensure the provision of high quality and timely emergency pre-hospital care services, using all available resources as efficiently and effectively as possible. As with any pre-hospital service, development and modernisation is an ongoing process as technology and clinical standards change. A significant reform programme is under way and additional funding of €3.6 million and 43 staff have been provided in the 2014 national service plan. It is important to acknowledge that progress is being made. The single national control system due for completion in 2015 will improve our control and dispatch performance. We are continuing to develop the intermediate care service, ICS, which transports patients between facilities, allowing emergency vehicles to focus on emergency calls. The ICS now carries three quarters of the non-emergency workload. We are also moving to more efficient on-duty rostering and to develop a national rostering system. I gather this is what the Deputy was referring to in respect of the "Prime Time" programme.

The emergency aeromedical service is operated from Athlone by the Air Corps and staffed by National Ambulance Service advanced paramedics. The EAS provides swift transfers of seriously ill or injured patients to appropriate hospitals. I fully accept that we need to drive further improvement; no one is denying that. Two national reviews are under way for a better service for patients. This country is difficult to compare with other areas because our geographic spread is different.

The Health Information and Quality Authority's governance review is examining how the NAS can develop and benchmark its services with modern outcome and indicator data. The NAS has commissioned an independent capacity review to determine current and future service needs. Among the areas being examined are staff numbers and skill mix as well as resource locations. Given its rural nature and road network, the western area provides a challenge for targeted response times for pre-hospital emergency care. The NAS recognises this and has undertaken specific measures to meet this challenge. The ICS has been rolled out in the west, including at Castlebar, Sligo and Galway. Almost 50 intermediate care operatives are now in place in the west.

There have been over 700 EAS completed missions since June 2012. One third of these have been ST-segment elevation myocardial infarction heart attacks, allowing these patients to be treated in a specialist setting within 90 minutes of diagnosis. Most of these occurred in west and northwest. I know this to be true because it happened to a friend of mine recently. This development allows ambulance crews to remain in their areas in the west, ready to respond to any other emergency calls. Additional advanced paramedics have been trained throughout the west, with the objective that each station will have an AP and to ensure the spread of APs throughout the region. Castlebar control will be integrated into Ballyshannon in order that crews can be dispatched throughout the region more efficiently and deployed across regional boundaries, as required.

The NAS is moving towards a more dynamic and tactical model of service delivery. The current model, where ambulances remain at a single station, will change to a model in which they are deployed from a central location and move to several sites during a shift rather than remaining at a single point until required. This will ensure greater geographical cover as well as improved response times and patient outcomes. I am confident that these reforms and reviews will lead to improvements in pre-hospital emergency care services to the benefit of people living in the west. Having said that, I agree with the Deputy that there is more to be done.

Deputy Colm Keaveney

I am pleased the Minister of State acknowledges that there is more to be done. I imagine the Minister of State is aware that there are over 84 vehicles in the National Ambulance Service that have approximately 350,000 km clocked up on their odometers. When making comparisons we should not suggest that the geography presents a unique challenge. Let us compare the region to Scotland, which has a comparable challenge in terms of population, rural isolation and connectivity. Given its geographic area Scotland is approximately as challenging as the region I live in. For example, Scotland has a comparable volume of call-outs. However, it spends twice the budget. It has a significant cohort of staff, far in excess of our National Ambulance Service. I call on the Minister of State to come back to us in future and to be prepared to examine where we are going to go in this budget in respect of the recruitment of emergency medical technicians. I call on the Minister of State to follow through with the strategic plan that, we understood, was to be rolled out in what is called the Bermuda Triangle, comprising the area from Tuam to Boyle to Castlerea. I call on the Minister of State to map out a specific element of understanding of what is required to follow through with the commitments given by the Government. There was one broken promise when the Roscommon accident and emergency unit closed, but the second broken promise was that the Government did not follow up and invest in response times, emergency medical technician staffing, ambulance bases and a modern fleet worthy of the citizens in the area. The people there have a high expectation and believe the vehicles should be up to standard.

I intend to come back to discuss the matter with the Minister of State again. It is something that we must work on together. We are entitled to the best of public service investment and we want to see an emergency response unit as part of our ambulance service that is fit-for-purpose.

Deputy Kathleen Lynch

The recent referendum in Scotland highlighted many things, one of which was that the investment in individual citizens in Scotland is approximately five times more than the corresponding figure in either Wales or certain parts of England. We are not comparing like with like. We do not have the luxury of allocating funds to a greater degree to one area over another.

The NAS has sought funding for 2015 to facilitate an improvement in the ambulance service in the west and to meet capacity and HIQA review recommendations. Funding to the value of approximately €1.2 million is required to staff ambulance stations in Tuam and Mulranny on a 24 hour, seven day basis. In addition, approximately €1.7 million is required to eliminate on-call in the west. Conversion of the vacated Garda station to an ambulance station in Loughglinn, County Roscommon, has commenced and will be completed in a few weeks time. That should answer some of the Deputy's concerns.

Medical Card Eligibility

Deputy Róisín Shortall

I thank the Minister of State for coming to the House to address this topic. Apart from housing, the loss of medical cards for those over 70 years is the main issue that I am dealing with in my office at the moment. I imagine this is probably the case for most other Deputies as well. I need not remind the Minister of State that following the elections in May the loss of medical cards was identified as the number one reason why the Government took a trouncing. All of the attention seemed to be focused on the loss of discretionary medical cards and a decision was taken to restore them. However, what was not highlighted at the time and what is one of the biggest problems relating to medical cards is that the income limit for those over 70 years has been cut so drastically.

The Minister of State will recall that for a number of years up to 2008 everybody aged over 70 was entitled to a medical card. When the then Minister for Health, Ms Mary Harney, announced she would introduce an income limit, there were huge protests. The leaders of the main Opposition parties at the time, Deputies Enda Kenny and Eamon Gilmore, were on the platform at a protest on Molesworth Street supporting the pensioners and they decried the fact that income limits were being introduced. However, they were introduced and they worked reasonably well in so far as they were set at a level that enabled the vast majority of the over 70s to retain their cards. Approximately 5% of medical card holders lost theirs as a result of that decision.

That was fine until last year when the Taoiseach and the then Tánaiste, Deputy Gilmore, supported a proposal in the budget to cut the income limits for those aged 70 again to €1,200 per week for a couple and €600 for a single person. That was bad enough, given it kicked in in April 2013, but a second cut was announced in last October's budget, which meant that in less than a year the income limits were cut twice. That resulted in a cut of €500 per week for couples and this has had a drastic impact on access to medical card cover. Members are dealing with this every day. The major difference in the income limits for those aged over 70 and those aged under 70 is gross income is used for the over 70s and no consideration is given to the medical or other expenses they incur. They are inclined to have significant medical conditions because of their age.

A great many of those in their late 70s, 80s or 90s are put through the mill in medical card reviews. They receive calls to provide information on their financial circumstances with many of them told they have exceeded the income limit and they will lose their medical card and, instead, be awarded a GP visit card. That is a poor consolation for an elderly person who needs access to community services because the medical card is the passport to such services, including public health nurses, physiotherapy in the case of somebody who has had a stroke, speech and language therapy, which is also important for older people, and home helps. These are key services in enabling people to remain in their homes and out of nursing homes.

What is going on makes no sense whatsoever. It is wrong that the Minister of State is doing this to elderly people, many of whom are extremely ill. It also makes no sense from a financial point of view. The system needs to be changed.

Deputy Kathleen Lynch

I am glad the Deputy has raised the issue because she understands it well given she was centrally involved in the review system and what we were going to do with primary care. I will not use the official script because she understands the issue so well.

The income limits involved are €500 per week for a single person and €900 for a couple. Nine out of ten people aged over 70 have either a GP only card or a medical card. I am glad the Deputy raised the question of access to other services and the passport into other services. We are examining how to separate access to community services, which the Deputy was involved in at the time. This is where we need to go to develop a proper community-based primary care system that does not require someone to have that passport in order that if someone needs access to a community service, it should be available or if he or she needs medical aids or appliances, they are available. Access to physiotherapy, including intensive rehabilitation, and so on should not be dependent on having a medical card.

Nine out of every ten people aged over 70 has access to a GP free of charge and their drugs bill is only €33 a week. The Deputy is correct that at this stage in life, people will more than likely have a chronic condition, even though people are living longer and are healthier, but they can still apply for a discretionary medical card where all the circumstances she outlined are taken into account and they will be treated in the same way. If one's needs are such that one cannot provide for oneself in respect of medical bills, one will be looked on favourably for a discretionary card. In reforming the system, we need to take a serious look at how people access the services they need because it is not always about access to a GP or drugs, it is also about access to community care services. That is what we need to build up and that is what we are doing now.

I thank the Deputy for raising the issue and I am glad it is her who did because she understands it perfectly.

Deputy Róisín Shortall

Even in the worst days of the recession, we managed to retain the existing income limits in 2011 and 2012 and it is difficult to understand how three Ministers in the Department could allow two substantial cuts to take place. That was disgraceful at a time they were talking about improving access to medical services, especially for people with medical needs.

The Minister of State referred to the GP visit card. It is not of much use to those aged over 70 because they still face substantial drugs costs and the issue is ensuring access to community services. She said nothing in her reply that indicates that work is being done in this regard. If work is ongoing, people should at least be permitted to retain their medical card until an alternative system is put in place.

Proper access for people needs to be ensured. The Minister of State said that if somebody loses a medical card, he or she can apply on discretionary grounds. Over the past few weeks, I have dealt with several people who have serious medical conditions. I am dealing with one couple in their 80s. The husband is in hospital and the wife is dealing with her own medical conditions. They are expected to find supporting evidence for a new application. They have been told to apply using the under 70s income limits. Rather than people in those circumstances being put through the mill and expected to produce all this documentation while their cover has been removed, the Minister of State should at least introduce a system, if she is not going to ensure net income is used, whereby the medical expenses of those aged over 70 are taken into consideration. That is the key issue. If a person has substantial medical expenses, there should be a way to take them into account while considering their application using the over 70s income limits.

The application of income limits currently is too rigid. They are applied on a gross basis and there is no room to consider medical expenses. The Minister of State is causing huge hardship to people at a time they feel vulnerable and have serious medical conditions. It is wrong that she is putting so many elderly people through the mill like this. I ask her to give this issue her urgent attention.

Deputy Kathleen Lynch

This is getting not just urgent but ongoing consideration and it is being worked on. There is a great deal of work to be done but we are working on this continuously and it is considered an urgent issue.

Despite the fact that we have been in the teeth of a recession, more people hold medical cards than ever before.

Deputy Róisín Shortall

Not in the over 70s age group.

Deputy Kathleen Lynch

Let me tell the Deputy about those aged over 70 years. As of 1 September 2014, the number of people aged over 70 holding a medical card stood at 332,872, of whom 5,078 held discretionary medical cards. Some 23,542 people aged over 70 years had a general practitioner visit card on 1 September, of whom 628 held discretionary medical cards. It is not the case that the system is not working, although I accept that it needs more tweaking. We are working on the system.

The number of people with a medical card is higher than ever owing to the recession, unemployment and increased life expectancy. For this reason, we had to spread the resources available to us more thinly. People have the option of applying for a discretionary medical card and all the issues raised by the Deputy can be taken into account in the application process. Welfare officers have been instructed to help people who are applying for discretionary medical cards.